Healthcare Provider Details

I. General information

NPI: 1801653621
Provider Name (Legal Business Name): MARITZA KANDZER MSN, PMHNP, AGPCNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2024
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3637 4TH ST N STE 480
ST PETERSBURG FL
33704-1337
US

IV. Provider business mailing address

3637 4TH ST N STE 480
ST PETERSBURG FL
33704-1337
US

V. Phone/Fax

Practice location:
  • Phone: 727-894-2341
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN11031585
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: