Provider Demographics
NPI:1457660367
Name:NAZARIO, MARIA (LMT)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:NAZARIO
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12606 SOPHIAMARIE LOOP
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32828-7177
Mailing Address - Country:US
Mailing Address - Phone:407-948-5345
Mailing Address - Fax:407-704-5011
Practice Address - Street 1:12606 SOPHIAMARIE LOOP
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32828-7177
Practice Address - Country:US
Practice Address - Phone:407-948-5345
Practice Address - Fax:407-704-5011
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-27
Last Update Date:2010-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA60221172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker