Provider Demographics
NPI:1669902326
Name:JARAMILLO, CARMEN GUADALUPE (DO)
Entity type:Individual
Prefix:
First Name:CARMEN
Middle Name:GUADALUPE
Last Name:JARAMILLO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1903 E FLETCHER AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33612-3713
Mailing Address - Country:US
Mailing Address - Phone:813-344-1084
Mailing Address - Fax:813-803-5444
Practice Address - Street 1:1903 E FLETCHER AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612-3713
Practice Address - Country:US
Practice Address - Phone:813-344-1084
Practice Address - Fax:813-803-5444
Is Sole Proprietor?:No
Enumeration Date:2017-06-15
Last Update Date:2020-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS16185207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine