Provider Demographics
NPI:1255876470
Name:ASSIS, CAROLINA GRADVOHL (ARNP, FNP)
Entity type:Individual
Prefix:
First Name:CAROLINA
Middle Name:GRADVOHL
Last Name:ASSIS
Suffix:
Gender:F
Credentials:ARNP, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1825 N CORPORATE LAKES BLVD
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33326-3211
Mailing Address - Country:US
Mailing Address - Phone:954-349-1111
Mailing Address - Fax:
Practice Address - Street 1:1825 N CORPORATE LAKES BLVD
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33326-3211
Practice Address - Country:US
Practice Address - Phone:954-349-1111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-24
Last Update Date:2016-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9364968363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily