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General NPI Number Information
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NPI Number | 1922501782
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Entity Type | Individual
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Provider Name | NERISSA DELANSIG AQUINO DDS
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Gender | Female
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Dates
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Enumeration Date | 03/16/2018
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Last Update Date | 09/30/2019
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Provider Practice Location Address
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Address Line | 2688 SW IMMANUEL DR
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City | PALM CITY
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State | FL
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Zip | 34990-2738
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Country | US
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Telephone | 772-286-8600
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Fax |
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Provider Business Mailing Address
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Address Line | 3415 SW ELLIS ST
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City | PORT SAINT LUCIE
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State | FL
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Zip | 34953-5100
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DN23620
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License Number State | FL
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