Healthcare Provider Details

I. General information

NPI: 1508264417
Provider Name (Legal Business Name): ENVER RUZDIJA ARNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2014
Last Update Date: 10/11/2022
Certification Date: 07/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13670 WALSINGHAM RD
LARGO FL
33774-3532
US

IV. Provider business mailing address

13670 WALSINGHAM RD
LARGO FL
33774-3532
US

V. Phone/Fax

Practice location:
  • Phone: 727-593-9848
  • Fax: 727-596-4532
Mailing address:
  • Phone: 727-593-9848
  • Fax: 727-596-4532

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberARNP9264115
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: