Provider Demographics
NPI:1275082596
Name:ALTIDOR, DANIELA JOSEPH FISIAS (APRN, FNP-BC, NI-BC)
Entity Type:Individual
Prefix:
First Name:DANIELA
Middle Name:JOSEPH FISIAS
Last Name:ALTIDOR
Suffix:
Gender:F
Credentials:APRN, FNP-BC, NI-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4026 NW 38TH AVE
Mailing Address - Street 2:
Mailing Address - City:LAUDERDALE LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33309-4813
Mailing Address - Country:US
Mailing Address - Phone:954-268-9044
Mailing Address - Fax:
Practice Address - Street 1:4026 NW 38TH AVE
Practice Address - Street 2:
Practice Address - City:LAUDERDALE LAKES
Practice Address - State:FL
Practice Address - Zip Code:33309-4813
Practice Address - Country:US
Practice Address - Phone:954-268-9044
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-28
Last Update Date:2023-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9256027163WC0400X, 163WR0400X
FL11028904364SI0800X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WC0400XNursing Service ProvidersRegistered NurseCase Management
No163WR0400XNursing Service ProvidersRegistered NurseRehabilitation
No364SI0800XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistInformatics