Provider Demographics
NPI:1679654727
Name:HORTA VELAZQUEZ, ADLINE M (MD)
Entity Type:Individual
Prefix:
First Name:ADLINE
Middle Name:M
Last Name:HORTA VELAZQUEZ
Suffix:
Gender:F
Credentials:MD
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1140 S SEMORAN BLVD
Mailing Address - Street 2:SUITE
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32807-1459
Mailing Address - Country:US
Mailing Address - Phone:407-384-9165
Mailing Address - Fax:407-384-9174
Practice Address - Street 1:1140 S SEMORAN BLVD
Practice Address - Street 2:SUITE E
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32807-1459
Practice Address - Country:US
Practice Address - Phone:407-384-9165
Practice Address - Fax:407-384-9174
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLACN503207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL11679932Medicaid
FL11679932Medicaid
FLBH8929804OtherDEA
FLGJ442ZMedicare PIN
PR7910099OtherHUMANA PR