Basic Information
Provider Information
NPI: 1902307754
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: DELGADO
FirstName: ANDRES
MiddleName:  
NamePrefix: MR.
NameSuffix: JR.
Credential: ARNP-C
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 38135 MARKET SQ
Address2:  
City: ZEPHYRHILLS
State: FL
PostalCode: 335427505
CountryCode: US
TelephoneNumber: 3525670188
FaxNumber: 8133555101
Practice Location
Address1: 2352 BRUCE B DOWNS BLVD STE 206
Address2:  
City: WESLEY CHAPEL
State: FL
PostalCode: 335449203
CountryCode: US
TelephoneNumber: 8135284843
FaxNumber: 8133555052
Other Information
ProviderEnumerationDate: 02/27/2018
LastUpdateDate: 08/31/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LF0000XARNP9203161FLY193400000X SINGLE SPECIALTY GROUPPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

No ID Information.


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