Provider Demographics
NPI:1982480448
Name:ALFONZO, CARLOS L (ARNP)
Entity Type:Individual
Prefix:MR
First Name:CARLOS
Middle Name:L
Last Name:ALFONZO
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:317 ASHBURTON WAY
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34758-4223
Mailing Address - Country:US
Mailing Address - Phone:407-342-7992
Mailing Address - Fax:
Practice Address - Street 1:317 ASHBURTON WAY
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34758-4223
Practice Address - Country:US
Practice Address - Phone:407-342-7992
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-31
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3694115163WN0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WN0800XNursing Service ProvidersRegistered NurseNeuroscience