Provider Demographics
NPI:1790143493
Name:ESTANGA, NELLYS (RN, BSN)
Entity Type:Individual
Prefix:
First Name:NELLYS
Middle Name:
Last Name:ESTANGA
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 E FOREST PARK DR
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32962-4643
Mailing Address - Country:US
Mailing Address - Phone:954-618-8200
Mailing Address - Fax:
Practice Address - Street 1:180 E FOREST PARK DR
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32962-4643
Practice Address - Country:US
Practice Address - Phone:954-618-8200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-09
Last Update Date:2016-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9301615163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse