Provider Demographics
NPI:1346572385
Name:CALDERON, NANCY L (ARNP)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:L
Last Name:CALDERON
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2501 W KENNEDY BLVD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33609-3305
Mailing Address - Country:US
Mailing Address - Phone:813-844-1385
Mailing Address - Fax:813-254-0230
Practice Address - Street 1:2501 W KENNEDY BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-3305
Practice Address - Country:US
Practice Address - Phone:813-844-1385
Practice Address - Fax:813-254-0230
Is Sole Proprietor?:No
Enumeration Date:2010-02-02
Last Update Date:2021-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9199206363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001921700Medicaid