Provider Demographics
NPI:1205583093
Name:RAMOS MARTINEZ, CARLOS EDUARDO
Entity type:Individual
Prefix:
First Name:CARLOS
Middle Name:EDUARDO
Last Name:RAMOS MARTINEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7908 SPRING VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33615-2117
Mailing Address - Country:US
Mailing Address - Phone:813-802-0468
Mailing Address - Fax:
Practice Address - Street 1:2460 TAMIAMI TRL STE A
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-3922
Practice Address - Country:US
Practice Address - Phone:855-674-7400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-02
Last Update Date:2022-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN1101840363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily