Provider Demographics
NPI:1588292205
Name:DELLATORRE, DORA HELENE (NP)
Entity type:Individual
Prefix:
First Name:DORA
Middle Name:HELENE
Last Name:DELLATORRE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2231 BRIDGEPORT CIR
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-4345
Mailing Address - Country:US
Mailing Address - Phone:321-749-5835
Mailing Address - Fax:
Practice Address - Street 1:2231 BRIDGEPORT CIR
Practice Address - Street 2:
Practice Address - City:ROCKLEDGE
Practice Address - State:FL
Practice Address - Zip Code:32955-4345
Practice Address - Country:US
Practice Address - Phone:321-749-5835
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-29
Last Update Date:2020-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11006421363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily