Provider Demographics
NPI:1720219884
Name:ANZARDO-CALZADILLA, NELSON (NP)
Entity Type:Individual
Prefix:DR
First Name:NELSON
Middle Name:
Last Name:ANZARDO-CALZADILLA
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7925 NW 12TH ST
Mailing Address - Street 2:SUITE 118
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33126-1827
Mailing Address - Country:US
Mailing Address - Phone:305-297-5693
Mailing Address - Fax:305-397-1860
Practice Address - Street 1:15607 SW 63RD TER
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33193-2803
Practice Address - Country:US
Practice Address - Phone:305-297-5693
Practice Address - Fax:305-397-1860
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-06
Last Update Date:2017-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 9292637163W00000X
GUPN5185397164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Yes163W00000XNursing Service ProvidersRegistered Nurse