Healthcare Provider Details

I. General information

NPI: 1932780517
Provider Name (Legal Business Name): WILDELYS SANTOS ALVARADO APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/15/2021
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1820 N HANCOCK RD STE 220
MINNEOLA FL
34715-8182
US

IV. Provider business mailing address

1919 E HIGHWAY 50
CLERMONT FL
34711-1975
US

V. Phone/Fax

Practice location:
  • Phone: 689-289-2650
  • Fax: 689-289-2651
Mailing address:
  • Phone: 352-717-3765
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11012678
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: