Individual
CARMELO M LICITRA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
521 W STATE ROAD 434 STE 305, LONGWOOD, FL 32750-5166
(407) 423-1039
(407) 425-2347
Mailing address
521 W STATE ROAD 434 STE 305, LONGWOOD, FL 32750-5166
(407) 423-1039
(407) 425-2347
Taxonomy
Speciality
Code
Description
License number
State
207RI0200X
Infectious Disease Physician
Primary
ME0042655
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
041558800
—
FL
01
—
64535
BCBS
FL
Enumeration date
02/23/2006
Last updated
04/21/2026
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