Healthcare Provider Details

I. General information

NPI: 1801255153
Provider Name (Legal Business Name): DAFNE LYDIA BUZNEGO ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/15/2016
Last Update Date: 12/07/2021
Certification Date: 12/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5564 E GRANT ST
ORLANDO FL
32822-1666
US

IV. Provider business mailing address

5564 E GRANT ST
ORLANDO FL
32822-1666
US

V. Phone/Fax

Practice location:
  • Phone: 321-235-6230
  • Fax: 321-235-6246
Mailing address:
  • Phone: 321-235-6230
  • Fax: 321-235-6246

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberARNP9273943
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberARNP9273943
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: