Provider Demographics
NPI:1184343519
Name:VELAZQUEZ FUNDORA, CLAUDIA (APRN)
Entity type:Individual
Prefix:
First Name:CLAUDIA
Middle Name:
Last Name:VELAZQUEZ FUNDORA
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19721 NW 77TH CT
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-6403
Mailing Address - Country:US
Mailing Address - Phone:786-804-7067
Mailing Address - Fax:
Practice Address - Street 1:19721 NW 77TH CT
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33015-6403
Practice Address - Country:US
Practice Address - Phone:786-804-7067
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-29
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9496219163W00000X
FL11021561363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse