Basic Information
| Provider Information | |||||||||
| NPI: | 1659628089 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CARRERAS-MIRANDA | ||||||||
| FirstName: | FRANCISCO | ||||||||
| MiddleName: | JOSE | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2066 | ||||||||
| Address2: | |||||||||
| City: | LECANTO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 344602066 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3525630931 | ||||||||
| FaxNumber: | 3525630935 | ||||||||
| Practice Location | |||||||||
| Address1: | 1990 N PROSPECT AVE | ||||||||
| Address2: | |||||||||
| City: | LECANTO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 344619792 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3525276888 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/03/2012 | ||||||||
| LastUpdateDate: | 10/14/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/14/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208D00000X | 18636 | PR | N | Allopathic & Osteopathic Physicians | General Practice | 208D00000X | ACN1157 | FL | Y | Allopathic & Osteopathic Physicians | General Practice |
ID Information
| ID | Type | State | Issuer | Description | 103304000 | 05 | FL | MEDICAID |