Basic Information
| Provider Information | |||||||||
| NPI: | 1598202517 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RAUDEZ | ||||||||
| FirstName: | CAROLINA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12245 CROTON WAY | ||||||||
| Address2: | |||||||||
| City: | HOLLYWOOD | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330263647 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3053108084 | ||||||||
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| Practice Location | |||||||||
| Address1: | 6517 TAFT ST | ||||||||
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| City: | HOLLYWOOD | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330244062 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9549839191 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/28/2017 | ||||||||
| LastUpdateDate: | 03/23/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 03/23/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | ARNP9311223 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.