Provider Demographics
NPI:1598835407
Name:ANDERSON, WALESKA LLORENS (RN)
Entity Type:Individual
Prefix:
First Name:WALESKA
Middle Name:LLORENS
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:618 SCENIC ST
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34748-6226
Mailing Address - Country:US
Mailing Address - Phone:352-206-6343
Mailing Address - Fax:352-728-3719
Practice Address - Street 1:618 SCENIC ST
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748-6226
Practice Address - Country:US
Practice Address - Phone:352-206-6343
Practice Address - Fax:352-728-3719
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9169817163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice