Provider Demographics
NPI:1306677455
Name:VIDALLO, ARI (FNP-C)
Entity type:Individual
Prefix:
First Name:ARI
Middle Name:
Last Name:VIDALLO
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1921 S KIRKMAN RD APT 218
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32811-2318
Mailing Address - Country:US
Mailing Address - Phone:407-561-3128
Mailing Address - Fax:
Practice Address - Street 1:1720 SE 16TH AVE STE 304-C
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-4620
Practice Address - Country:US
Practice Address - Phone:352-857-8417
Practice Address - Fax:352-657-2435
Is Sole Proprietor?:No
Enumeration Date:2024-08-12
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11034674363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily