=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083404602
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANA M BRICENO APRN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/07/2025
-----------------------------------------------------
Last Update Date | 05/07/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 401 W OAK ST
-----------------------------------------------------
City | KISSIMMEE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34741-4931
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-674-2044
-----------------------------------------------------
Fax | 407-674-2049
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4141 TWILIGHT TRL
-----------------------------------------------------
City | KISSIMMEE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34746-3247
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 689-265-7803
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | APRN11039302
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------