Provider Demographics
NPI:1083916944
Name:PROENZA, NILDA (CASE MANAGER)
Entity Type:Individual
Prefix:
First Name:NILDA
Middle Name:
Last Name:PROENZA
Suffix:
Gender:F
Credentials:CASE MANAGER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3339 E TAMIAMI TRL
Mailing Address - Street 2:SUITE 145
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34112-5361
Mailing Address - Country:US
Mailing Address - Phone:239-252-2697
Mailing Address - Fax:239-252-2552
Practice Address - Street 1:3339 E TAMIAMI TRL
Practice Address - Street 2:SUITE 145
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34112-5361
Practice Address - Country:US
Practice Address - Phone:239-252-2697
Practice Address - Fax:239-252-2552
Is Sole Proprietor?:No
Enumeration Date:2010-11-29
Last Update Date:2010-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator