Provider Demographics
NPI:1861164410
Name:CARBALLO CUE, FRANK L (APRN)
Entity type:Individual
Prefix:
First Name:FRANK
Middle Name:L
Last Name:CARBALLO CUE
Suffix:
Gender:M
Credentials:APRN
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Mailing Address - Street 1:425 W COLONIAL DR STE 303
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32804-6863
Mailing Address - Country:US
Mailing Address - Phone:321-332-6947
Mailing Address - Fax:407-286-4515
Practice Address - Street 1:780 BUENAVENTURA BLVD
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34743-8128
Practice Address - Country:US
Practice Address - Phone:407-274-9590
Practice Address - Fax:407-593-6102
Is Sole Proprietor?:No
Enumeration Date:2021-10-01
Last Update Date:2024-08-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLAPRN11015088363LF0000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL112801300Medicaid
FLAPRN11015088OtherSTATE MEDICAL LICENSE