Provider Demographics
NPI:1225809809
Name:SIBAJA CALDERON, EMEL D (APRN, AGACNP-BC)
Entity Type:Individual
Prefix:
First Name:EMEL
Middle Name:D
Last Name:SIBAJA CALDERON
Suffix:
Gender:M
Credentials:APRN, AGACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:457 ADRIEL AVE
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33880-5529
Mailing Address - Country:US
Mailing Address - Phone:863-608-1860
Mailing Address - Fax:
Practice Address - Street 1:405 LIONEL WAY
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:FL
Practice Address - Zip Code:33837-7811
Practice Address - Country:US
Practice Address - Phone:863-353-1390
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-11
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11030586363LC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LC0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCritical Care Medicine