Provider Demographics
NPI:1013149723
Name:CARNEVALE, CAROLINE (FNP, MPH)
Entity type:Individual
Prefix:
First Name:CAROLINE
Middle Name:
Last Name:CARNEVALE
Suffix:
Gender:F
Credentials:FNP, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:622 W 168TH ST
Mailing Address - Street 2:VC4 - 432
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032-3720
Mailing Address - Country:US
Mailing Address - Phone:646-319-4676
Mailing Address - Fax:212-305-7400
Practice Address - Street 1:622 W 168TH ST
Practice Address - Street 2:VC4 - 432
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-3720
Practice Address - Country:US
Practice Address - Phone:646-319-4676
Practice Address - Fax:212-305-7400
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-13
Last Update Date:2015-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF335816-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily