Provider Demographics
NPI:1154092682
Name:SEGARRA-RIVERA, CARLA YOLANDA
Entity type:Individual
Prefix:
First Name:CARLA
Middle Name:YOLANDA
Last Name:SEGARRA-RIVERA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CARLA
Other - Middle Name:YOLANDA
Other - Last Name:SEGARRA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:873 DOLPHIN AVE NW
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33948-6313
Mailing Address - Country:US
Mailing Address - Phone:770-733-9917
Mailing Address - Fax:
Practice Address - Street 1:517 TAMIAMI TRL
Practice Address - Street 2:
Practice Address - City:PUNTA GORDA
Practice Address - State:FL
Practice Address - Zip Code:33950-5520
Practice Address - Country:US
Practice Address - Phone:941-625-0600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-23
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9463269163W00000X
FLAPRN11029607363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No163W00000XNursing Service ProvidersRegistered Nurse