Basic Information
| Provider Information | |||||||||
| NPI: | 1356702997 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | EXTRA | ||||||||
| FirstName: | CARMANTE | ||||||||
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| NamePrefix: | MRS. | ||||||||
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| Credential: | DNP, ARNP, FNP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1031 NE 138TH ST | ||||||||
| Address2: | |||||||||
| City: | NORTH MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331613823 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3057990443 | ||||||||
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| Practice Location | |||||||||
| Address1: | 8100 SW 10TH ST | ||||||||
| Address2: | |||||||||
| City: | PLANTATION | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333243279 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9542101190 | ||||||||
| FaxNumber: | 9542101085 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/10/2016 | ||||||||
| LastUpdateDate: | 03/15/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 364SF0001X | ARNP3360182 | FL | N | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Family Health | 363L00000X | ARNP3360182 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.