Provider Demographics
NPI:1619640026
Name:CARDOSO, DEANNA L (APRN, FNP-C)
Entity Type:Individual
Prefix:
First Name:DEANNA
Middle Name:L
Last Name:CARDOSO
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5308 W IRLO BRONSON MEMORIAL HWY
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34746-4754
Mailing Address - Country:US
Mailing Address - Phone:407-390-9431
Mailing Address - Fax:
Practice Address - Street 1:5308 W IRLO BRONSON MEMORIAL HWY
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34746-4754
Practice Address - Country:US
Practice Address - Phone:407-390-9431
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-30
Last Update Date:2022-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11014229363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily