Provider Demographics
NPI:1437612157
Name:DELPE, ANSON (ADMINISTRATOR)
Entity Type:Individual
Prefix:MR
First Name:ANSON
Middle Name:
Last Name:DELPE
Suffix:
Gender:M
Credentials:ADMINISTRATOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1694 NEPTUNE RD
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34744-4741
Mailing Address - Country:US
Mailing Address - Phone:508-345-5864
Mailing Address - Fax:407-386-9515
Practice Address - Street 1:1694 NEPTUNE RD
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34744-4741
Practice Address - Country:US
Practice Address - Phone:508-345-5864
Practice Address - Fax:407-386-9515
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-09
Last Update Date:2019-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11893310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility