Healthcare Provider Details

I. General information

NPI: 1295460053
Provider Name (Legal Business Name): MARIAN A MALDONADO SOLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2022
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1160 CYPRESS GLEN CIR
KISSIMMEE FL
34741-7560
US

IV. Provider business mailing address

1826 RED CANYON DR
KINDRED FL
34744-6096
US

V. Phone/Fax

Practice location:
  • Phone: 407-518-1074
  • Fax:
Mailing address:
  • Phone: 407-577-5705
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11020733
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: