Provider Demographics
NPI:1861140857
Name:YEARWOOD, CARLA ANTONETTE
Entity type:Individual
Prefix:
First Name:CARLA
Middle Name:ANTONETTE
Last Name:YEARWOOD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11306 MAYBROOK AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33569-5900
Mailing Address - Country:US
Mailing Address - Phone:443-418-0541
Mailing Address - Fax:
Practice Address - Street 1:11306 MAYBROOK AVE
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33569-5900
Practice Address - Country:US
Practice Address - Phone:443-418-0541
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-17
Last Update Date:2022-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide