Provider Demographics
NPI:1649960022
Name:EMCARA HEALTH OF PUERTO RICO, LLC
Entity type:Organization
Organization Name:EMCARA HEALTH OF PUERTO RICO, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING & CONTRACTING
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:CARRIEDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-793-7050
Mailing Address - Street 1:113 SEABOARD LN STE 200B
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-8282
Mailing Address - Country:US
Mailing Address - Phone:800-793-7050
Mailing Address - Fax:
Practice Address - Street 1:450 CONSTITUTION AVE
Practice Address - Street 2:TORRE DE LA REINA SUITE 200
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00901
Practice Address - Country:US
Practice Address - Phone:800-793-7050
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-10
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontologyGroup - Single Specialty