Provider Demographics
NPI:1215064803
Name:CARRIE, NATALIE
Entity type:Individual
Prefix:MS
First Name:NATALIE
Middle Name:
Last Name:CARRIE
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 1:20250 NE 3RD CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33179-5203
Mailing Address - Country:US
Mailing Address - Phone:305-624-7450
Mailing Address - Fax:305-623-7893
Practice Address - Street 1:1825 NW 167TH ST
Practice Address - Street 2:SUITE #102
Practice Address - City:OPA LOCKA
Practice Address - State:FL
Practice Address - Zip Code:33056-4838
Practice Address - Country:US
Practice Address - Phone:305-624-7450
Practice Address - Fax:305-623-7893
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization