Provider Demographics
NPI:1891892857
Name:MARRERO, CARMITA (MD)
Entity Type:Individual
Prefix:
First Name:CARMITA
Middle Name:
Last Name:MARRERO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 ROWAN OAK PL
Mailing Address - Street 2:
Mailing Address - City:FERNANDINA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32034-9289
Mailing Address - Country:US
Mailing Address - Phone:904-321-4601
Mailing Address - Fax:
Practice Address - Street 1:1463 NECTARINE ST
Practice Address - Street 2:
Practice Address - City:FERNANDINA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32034-3027
Practice Address - Country:US
Practice Address - Phone:904-491-0177
Practice Address - Fax:904-491-3173
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME76419208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL254686800Medicaid