Provider Demographics
NPI:1326758293
Name:ZALDIVAR RICARDO, JOSE (APRN)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:
Last Name:ZALDIVAR RICARDO
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4709 ONYX PL
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33615-4923
Mailing Address - Country:US
Mailing Address - Phone:813-723-0546
Mailing Address - Fax:
Practice Address - Street 1:8726 W WATERS AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33615-1714
Practice Address - Country:US
Practice Address - Phone:813-712-1726
Practice Address - Fax:813-925-4640
Is Sole Proprietor?:No
Enumeration Date:2022-12-01
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11023190363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily