Healthcare Provider Details

I. General information

NPI: 1013364231
Provider Name (Legal Business Name): FELIDA M TIBURCIO R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2016
Last Update Date: 05/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3938 N CHAMBERLAIN BLVD
NORTH PORT FL
34286-9306
US

IV. Provider business mailing address

3938 N CHAMBERLAIN BLVD
NORTH PORT FL
34286-9306
US

V. Phone/Fax

Practice location:
  • Phone: 787-668-6039
  • Fax:
Mailing address:
  • Phone: 787-668-6039
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN9421345
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: