Provider Demographics
NPI:1487161261
Name:ARISTIZABAL, IDALUZ (APRN-BC)
Entity type:Individual
Prefix:
First Name:IDALUZ
Middle Name:
Last Name:ARISTIZABAL
Suffix:
Gender:F
Credentials:APRN-BC
Other - Prefix:
Other - First Name:IDALUZ
Other - Middle Name:
Other - Last Name:FERNANDEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:IDALUZ FERNANDEZ
Mailing Address - Street 1:2839 SW 13TH CT
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33312-2911
Mailing Address - Country:US
Mailing Address - Phone:305-218-4332
Mailing Address - Fax:
Practice Address - Street 1:1489 W PALMETTO PARK RD STE 401
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33486-3325
Practice Address - Country:US
Practice Address - Phone:305-218-4332
Practice Address - Fax:561-939-4124
Is Sole Proprietor?:No
Enumeration Date:2018-01-03
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9310537363LP2300X
FLARNP9310537363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care