Organization
ST.PETE NURSE PRACTITIONER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JESSICA CARABALLO ARNP (PRESIDENT)
(727) 686-8284
Entity
Organization
Contact information
Practice address
33 4TH ST N STE 202, SAINT PETERSBURG, FL 33701-3806
(727) 686-8284
Mailing address
4670 CHANCELLOR ST NE, SAINT PETERSBURG, FL 33703-4345
(727) 686-8284
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1437649100
—
FL
Enumeration date
05/09/2022
Last updated
05/09/2022
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