Provider Demographics
NPI:1386091676
Name:OROZCO, CARLO ROBERTO (FNP-C)
Entity type:Individual
Prefix:MR
First Name:CARLO
Middle Name:ROBERTO
Last Name:OROZCO
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 S 11TH ST STE 1
Mailing Address - Street 2:
Mailing Address - City:COEUR D'ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-4000
Mailing Address - Country:US
Mailing Address - Phone:208-243-9395
Mailing Address - Fax:951-466-2426
Practice Address - Street 1:212 S 11TH ST STE 1
Practice Address - Street 2:
Practice Address - City:COEUR D'ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-4000
Practice Address - Country:US
Practice Address - Phone:208-243-9395
Practice Address - Fax:951-466-2426
Is Sole Proprietor?:No
Enumeration Date:2016-05-17
Last Update Date:2023-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDNP65298363L00000X
ID65298363LF0000X, 363LP0808X, 363L00000X
WAAP61360767363LP0808X
CA95004065363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1386091676Medicaid