Provider Demographics
NPI:1851072003
Name:GOUDET DE CORRALES, CARMEN ELENA (APRN)
Entity Type:Individual
Prefix:
First Name:CARMEN
Middle Name:ELENA
Last Name:GOUDET DE CORRALES
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18255 NW 68TH AVE APT 324
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-3489
Mailing Address - Country:US
Mailing Address - Phone:305-299-7546
Mailing Address - Fax:
Practice Address - Street 1:8249 NW 36TH ST STE 104
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33166-6673
Practice Address - Country:US
Practice Address - Phone:305-299-7546
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-31
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11027785363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily