Provider Demographics
NPI:1720269228
Name:CARBALLO, RAFAEL (FNP-BC)
Entity Type:Individual
Prefix:MR
First Name:RAFAEL
Middle Name:
Last Name:CARBALLO
Suffix:
Gender:M
Credentials:FNP-BC
Other - Prefix:
Other - First Name:RAFAEL
Other - Middle Name:
Other - Last Name:CARBALLO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNP-BC
Mailing Address - Street 1:2415 NW 16TH STREET RD APT 208
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33125-1292
Mailing Address - Country:US
Mailing Address - Phone:786-301-9084
Mailing Address - Fax:
Practice Address - Street 1:2415 NW 16TH STREET RD APT 208
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33125-1292
Practice Address - Country:US
Practice Address - Phone:786-301-9084
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-27
Last Update Date:2020-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9199568163W00000X
FL11001321363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse