Provider Demographics
NPI:1710473996
Name:HADDOCK, CARLA TORRES (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:CARLA
Middle Name:TORRES
Last Name:HADDOCK
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:277 W CHALAN SANTO PAPA
Mailing Address - Street 2:
Mailing Address - City:HAGATNA
Mailing Address - State:GU
Mailing Address - Zip Code:96910-5115
Mailing Address - Country:US
Mailing Address - Phone:671-486-0000
Mailing Address - Fax:
Practice Address - Street 1:277 W CHALAN SANTO PAPA
Practice Address - Street 2:
Practice Address - City:HAGATNA
Practice Address - State:GU
Practice Address - Zip Code:96910-5115
Practice Address - Country:US
Practice Address - Phone:671-486-0000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-10
Last Update Date:2018-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GUNP0187363LA2100X, 363LF0000X
GURX0607163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
GUNP0187OtherNP LICENSE
GURX0607OtherRN LICENSE