Provider Demographics
NPI:1912716101
Name:XUNCAX, NILDA JUDITH
Entity type:Individual
Prefix:
First Name:NILDA
Middle Name:JUDITH
Last Name:XUNCAX
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:NILDA
Other - Middle Name:
Other - Last Name:FRANKLIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:15797 SW 151ST ST
Mailing Address - Street 2:
Mailing Address - City:INDIANTOWN
Mailing Address - State:FL
Mailing Address - Zip Code:34956-3412
Mailing Address - Country:US
Mailing Address - Phone:772-349-2125
Mailing Address - Fax:
Practice Address - Street 1:15797 SW 151ST ST
Practice Address - Street 2:
Practice Address - City:INDIANTOWN
Practice Address - State:FL
Practice Address - Zip Code:34956-3412
Practice Address - Country:US
Practice Address - Phone:772-349-2125
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-02
Last Update Date:2025-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11029499207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine