Provider Demographics
NPI:1720701691
Name:FANNIN, PAZ AMERICA (RN)
Entity Type:Individual
Prefix:
First Name:PAZ
Middle Name:AMERICA
Last Name:FANNIN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5637 PEACH DR
Mailing Address - Street 2:
Mailing Address - City:PACE
Mailing Address - State:FL
Mailing Address - Zip Code:32571-2775
Mailing Address - Country:US
Mailing Address - Phone:801-885-5802
Mailing Address - Fax:
Practice Address - Street 1:5637 PEACH DR
Practice Address - Street 2:
Practice Address - City:PACE
Practice Address - State:FL
Practice Address - Zip Code:32571-2775
Practice Address - Country:US
Practice Address - Phone:801-885-5802
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-26
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9431495163W00000X, 2080P0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0204XAllopathic & Osteopathic PhysiciansPediatricsPediatric Emergency Medicine
No163W00000XNursing Service ProvidersRegistered Nurse