Healthcare Provider Details

I. General information

NPI: 1992482806
Provider Name (Legal Business Name): NINOZZKA NEDEGE POLANCO APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2023
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1820 SW 43RD ST APT 4202
GAINESVILLE FL
32607-5937
US

IV. Provider business mailing address

1820 SW 43RD ST APT 4202
GAINESVILLE FL
32607-5937
US

V. Phone/Fax

Practice location:
  • Phone: 786-278-2159
  • Fax:
Mailing address:
  • Phone: 786-278-2159
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11027182
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: