Provider Demographics
NPI:1588871198
Name:STONE, CAROLA GUTIERREZ (RN)
Entity type:Individual
Prefix:
First Name:CAROLA
Middle Name:GUTIERREZ
Last Name:STONE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2640 SW 33RD AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33133-2806
Mailing Address - Country:US
Mailing Address - Phone:786-553-0654
Mailing Address - Fax:
Practice Address - Street 1:8175 NW 12TH ST
Practice Address - Street 2:SUITE 306
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33126-1828
Practice Address - Country:US
Practice Address - Phone:786-845-0173
Practice Address - Fax:786-845-0176
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9226812163W00000X
FLAPRN11032619363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1720171895Medicaid