Provider Demographics
NPI:1982024568
Name:WALDO, IZABELLA (APRN)
Entity Type:Individual
Prefix:MRS
First Name:IZABELLA
Middle Name:
Last Name:WALDO
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:IZABELLA
Other - Middle Name:
Other - Last Name:WALDO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DNP
Mailing Address - Street 1:4100 S HOSPITAL DR STE 102
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33317-2831
Mailing Address - Country:US
Mailing Address - Phone:914-602-6209
Mailing Address - Fax:954-530-8945
Practice Address - Street 1:1951 NW 7TH AVE FL 3
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33136-1104
Practice Address - Country:US
Practice Address - Phone:305-902-6347
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-22
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9258093163W00000X
FL11004907363LP0808X
FLAPRN11004907363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLRN9258093OtherRN LICENSE