Healthcare Provider Details

I. General information

NPI: 1275082596
Provider Name (Legal Business Name): DANIELA JOSEPH FISIAS ALTIDOR APRN, FNP-BC, NI-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2016
Last Update Date: 12/02/2023
Certification Date: 12/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4026 NW 38TH AVE
LAUDERDALE LAKES FL
33309-4813
US

IV. Provider business mailing address

4026 NW 38TH AVE
LAUDERDALE LAKES FL
33309-4813
US

V. Phone/Fax

Practice location:
  • Phone: 954-268-9044
  • Fax:
Mailing address:
  • Phone: 954-268-9044
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number9256027
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code163WR0400X
TaxonomyRehabilitation Registered Nurse
License Number9256027
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code364SI0800X
TaxonomyInformatics Clinical Nurse Specialist
License Number11028904
License Number StateFL
# 4
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11028904
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: