Provider Demographics
NPI:1588936025
Name:CARBONARO, KELLY L (ARNP)
Entity type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:L
Last Name:CARBONARO
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:L
Other - Last Name:DANNECKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:1050 SE MONTEREY RD
Mailing Address - Street 2:#201
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34994-4512
Mailing Address - Country:US
Mailing Address - Phone:727-271-8415
Mailing Address - Fax:
Practice Address - Street 1:1050 SE MONTEREY RD
Practice Address - Street 2:#201
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-4512
Practice Address - Country:US
Practice Address - Phone:727-271-8415
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-30
Last Update Date:2014-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP3265352363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily