Provider Demographics
NPI:1972628519
Name:POVEDA, CAROLINA (ANP)
Entity type:Individual
Prefix:MRS
First Name:CAROLINA
Middle Name:
Last Name:POVEDA
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1730 HUMBLE PLACE DR
Mailing Address - Street 2:
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77338-5275
Mailing Address - Country:US
Mailing Address - Phone:281-446-4222
Mailing Address - Fax:
Practice Address - Street 1:1730 HUMBLE PLACE DR
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77338-5275
Practice Address - Country:US
Practice Address - Phone:281-446-4222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2015-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX727463363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX727463OtherSTATE LICENSE NUMBER