Provider Demographics
NPI:1851118962
Name:BRUZOS DE LOGORZ, ANIETTE NMN (RN)
Entity type:Individual
Prefix:MS
First Name:ANIETTE
Middle Name:NMN
Last Name:BRUZOS DE LOGORZ
Suffix:
Gender:
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 REDONDO DR
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-8900
Mailing Address - Country:US
Mailing Address - Phone:407-308-2080
Mailing Address - Fax:
Practice Address - Street 1:710 REDONDO DR
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-8900
Practice Address - Country:US
Practice Address - Phone:407-308-2080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-21
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9171605163WC0400X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WC0400XNursing Service ProvidersRegistered NurseCase Management