Provider Demographics
NPI:1932828308
Name:CARBALLOSA, YANET (FNP)
Entity Type:Individual
Prefix:
First Name:YANET
Middle Name:
Last Name:CARBALLOSA
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 RESERVE WAY APT 108
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34105-3820
Mailing Address - Country:US
Mailing Address - Phone:786-879-3413
Mailing Address - Fax:
Practice Address - Street 1:3601 LAKEWOOD BLVD
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34112-6145
Practice Address - Country:US
Practice Address - Phone:419-252-6031
Practice Address - Fax:800-564-5952
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-26
Last Update Date:2022-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLF07221201363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty