Healthcare Provider Details

I. General information

NPI: 1962837419
Provider Name (Legal Business Name): MARIE DESIREE VILLARUZ LACANDOLA APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DESIREE LACANDOLA APRN

II. Dates (important events)

Enumeration Date: 09/03/2013
Last Update Date: 04/02/2026
Certification Date: 04/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5979 VINELAND RD STE 109
ORLANDO FL
32819-7857
US

IV. Provider business mailing address

5979 VINELAND RD STE 109
ORLANDO FL
32819-7857
US

V. Phone/Fax

Practice location:
  • Phone: 866-986-2263
  • Fax:
Mailing address:
  • Phone: 866-986-2263
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberARNP9271357
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: