Healthcare Provider Details

I. General information

NPI: 1013431956
Provider Name (Legal Business Name): DERL RAYMOND BUZON APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2017
Last Update Date: 07/21/2022
Certification Date: 09/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

258 S CHICKASAW TRL STE 301
ORLANDO FL
32825-3501
US

IV. Provider business mailing address

258 S CHICKASAW TRL STE 301
ORLANDO FL
32825-3501
US

V. Phone/Fax

Practice location:
  • Phone: 407-303-7399
  • Fax: 407-303-7305
Mailing address:
  • Phone: 407-303-7399
  • Fax: 407-303-7305

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN9192392
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: