Healthcare Provider Details

I. General information

NPI: 1295159259
Provider Name (Legal Business Name): MARIA MAGDALENA AUSSENDORF RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MARIA MAGDALENA VAZQUEZ-AUSSENDORF RN

II. Dates (important events)

Enumeration Date: 02/12/2014
Last Update Date: 02/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4814 N DARBY AVE
TAMPA FL
33603-2604
US

IV. Provider business mailing address

4814 N DARBY AVE
TAMPA FL
33603-2604
US

V. Phone/Fax

Practice location:
  • Phone: 813-598-7711
  • Fax: 813-641-9278
Mailing address:
  • Phone: 813-598-7711
  • Fax: 813-641-9278

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberRN9188861
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: