Provider Demographics
NPI:1275561706
Name:DELGADO, ANNERIS L (PA)
Entity Type:Individual
Prefix:
First Name:ANNERIS
Middle Name:L
Last Name:DELGADO
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1875 BOGGY CREEK RD
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34744-4428
Mailing Address - Country:US
Mailing Address - Phone:407-343-2000
Mailing Address - Fax:407-343-2000
Practice Address - Street 1:1875 BOGGY CREEK RD
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34744-4428
Practice Address - Country:US
Practice Address - Phone:407-343-2000
Practice Address - Fax:407-343-2000
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9100722363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2921677-00Medicaid
FLE6659Medicare ID - Type Unspecified
FLQ49857Medicare UPIN