Provider Demographics
NPI:1992220388
Name:PUNZALAN, MARIA AGUEDA BABETTE (ARNP)
Entity Type:Individual
Prefix:
First Name:MARIA AGUEDA
Middle Name:BABETTE
Last Name:PUNZALAN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8725 IRMASTONE WAY
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32817-2535
Mailing Address - Country:US
Mailing Address - Phone:407-497-9696
Mailing Address - Fax:407-657-7971
Practice Address - Street 1:8725 IRMASTONE WAY
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32817-2535
Practice Address - Country:US
Practice Address - Phone:407-657-7971
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-07
Last Update Date:2017-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9335904363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily