Provider Demographics
NPI:1447035605
Name:GRANT, CARLA M (APRN)
Entity type:Individual
Prefix:
First Name:CARLA
Middle Name:M
Last Name:GRANT
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1065 NE 125TH ST STE 300
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33161-5833
Mailing Address - Country:US
Mailing Address - Phone:305-891-0050
Mailing Address - Fax:305-891-4228
Practice Address - Street 1:10301 HAGEN RANCH RD STE B200
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33437-3723
Practice Address - Country:US
Practice Address - Phone:561-752-9490
Practice Address - Fax:561-752-9491
Is Sole Proprietor?:No
Enumeration Date:2023-08-28
Last Update Date:2024-01-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLAPRN11027939363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health