Healthcare Provider Details

I. General information

NPI: 1780397893
Provider Name (Legal Business Name): DARIOLY TAVAREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2023
Last Update Date: 01/04/2023
Certification Date: 01/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

58 W MICHIGAN ST
ORLANDO FL
32806-4453
US

IV. Provider business mailing address

9229 LEELAND ARCHER BLVD
ORLANDO FL
32836-8839
US

V. Phone/Fax

Practice location:
  • Phone: 407-650-9220
  • Fax: 407-650-9110
Mailing address:
  • Phone: 603-943-4171
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11023781
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: