Healthcare Provider Details

I. General information

NPI: 1932228541
Provider Name (Legal Business Name): NANCY MIQUELINA RONDON BA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 6TH ST S DEPT 7470
ST PETERSBURG FL
33701-4816
US

IV. Provider business mailing address

4023 BRAEMERE DR
SPRING HILL FL
34609-0680
US

V. Phone/Fax

Practice location:
  • Phone: 727-767-8216
  • Fax: 727-767-4715
Mailing address:
  • Phone: 352-688-7258
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: