Healthcare Provider Details

I. General information

NPI: 1558040949
Provider Name (Legal Business Name): ANET PROENZA APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2023
Last Update Date: 07/13/2023
Certification Date: 07/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4308 N HABANA AVE
TAMPA FL
33607-6316
US

IV. Provider business mailing address

10011 OASIS PALM DR
TAMPA FL
33615-2779
US

V. Phone/Fax

Practice location:
  • Phone: 813-490-9495
  • Fax:
Mailing address:
  • Phone: 813-679-8443
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11027474
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: