Basic Information
| Provider Information | |||||||||
| NPI: | 1326348640 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DELGARDO | ||||||||
| FirstName: | DANA | ||||||||
| MiddleName: | C | ||||||||
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| Credential: | APN | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | DELGARDO | ||||||||
| OtherFirstName: | DANA | ||||||||
| OtherMiddleName: | C | ||||||||
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| OtherCredential: | APNC | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 4440 FRUITVILLE RD | ||||||||
| Address2: | |||||||||
| City: | SARASOTA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 342321926 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9413660134 | ||||||||
| FaxNumber: | 9414041760 | ||||||||
| Practice Location | |||||||||
| Address1: | 3155 STATE ROUTE 10 STE 204 | ||||||||
| Address2: | |||||||||
| City: | DENVILLE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 078343430 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7337031309 | ||||||||
| FaxNumber: | 8882105318 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/02/2010 | ||||||||
| LastUpdateDate: | 10/14/2020 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | M | ||||||||
| AuthorizedOfficialLastName: | |||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 10/14/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 337845 | NY | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363LF0000X | 26NJ00312700 | NJ | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.