Provider Demographics
NPI:1013774538
Name:PETION, CARLA
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:
Last Name:PETION
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3375 BURNS RD STE 204
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-4361
Mailing Address - Country:US
Mailing Address - Phone:561-515-3600
Mailing Address - Fax:561-658-7623
Practice Address - Street 1:3375 BURNS RD STE 204
Practice Address - Street 2:
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-4361
Practice Address - Country:US
Practice Address - Phone:561-515-3600
Practice Address - Fax:561-658-7623
Is Sole Proprietor?:No
Enumeration Date:2024-03-01
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11023417363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care