Provider Demographics
NPI:1760973861
Name:CALUNGCAGUIN, MARIA ROSELYN TECSON (CNP)
Entity Type:Individual
Prefix:
First Name:MARIA ROSELYN
Middle Name:TECSON
Last Name:CALUNGCAGUIN
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3611 PRESCOTT LOOP
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33810-2863
Mailing Address - Country:US
Mailing Address - Phone:786-342-5144
Mailing Address - Fax:
Practice Address - Street 1:3611 PRESCOTT LOOP
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33810-2863
Practice Address - Country:US
Practice Address - Phone:786-342-5144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-23
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9252304363LA2200X
NMCNP-57155363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily