Provider Demographics
NPI:1760116685
Name:CARRERO, CHRISTINE (MSN, AGNP-C)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:CARRERO
Suffix:
Gender:F
Credentials:MSN, AGNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5601 70TH DR E
Mailing Address - Street 2:
Mailing Address - City:ELLENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34222-2632
Mailing Address - Country:US
Mailing Address - Phone:321-314-2562
Mailing Address - Fax:
Practice Address - Street 1:333 TAMIAMI TRL S STE 183
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34285-2426
Practice Address - Country:US
Practice Address - Phone:941-373-1971
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-15
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11020709363LG0600X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology