Basic Information
Provider Information
NPI: 1548491681
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BELISLE
FirstName: CAROLINA
MiddleName: PAULA
NamePrefix:  
NameSuffix:  
Credential: CRNA
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1613 HARRISON PKWY
Address2: SUITE 200
City: SUNRISE
State: FL
PostalCode: 333232896
CountryCode: US
TelephoneNumber: 9548382371
FaxNumber: 9548511758
Practice Location
Address1: 9370 SUNSET DR
Address2: A-250
City: MIAMI
State: FL
PostalCode: 331735431
CountryCode: US
TelephoneNumber: 3055954510
FaxNumber:  
Other Information
ProviderEnumerationDate: 08/06/2009
LastUpdateDate: 08/06/2009
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
367500000XARNP9203446FLY Physician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered 

No ID Information.


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