Provider Demographics
NPI:1114762739
Name:FONTAL, CARLA KIMBERLY
Entity type:Individual
Prefix:
First Name:CARLA
Middle Name:KIMBERLY
Last Name:FONTAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2520 ZANDER TER
Mailing Address - Street 2:
Mailing Address - City:NORTH PORT
Mailing Address - State:FL
Mailing Address - Zip Code:34286-8818
Mailing Address - Country:US
Mailing Address - Phone:941-586-8160
Mailing Address - Fax:
Practice Address - Street 1:2520 ZANDER TER
Practice Address - Street 2:
Practice Address - City:NORTH PORT
Practice Address - State:FL
Practice Address - Zip Code:34286-8818
Practice Address - Country:US
Practice Address - Phone:941-586-8160
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-26
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9452266163WE0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WE0003XNursing Service ProvidersRegistered NurseEmergency