Provider Demographics
NPI:1992344055
Name:FUNDORA, DANISLEIDYS (APRN)
Entity type:Individual
Prefix:
First Name:DANISLEIDYS
Middle Name:
Last Name:FUNDORA
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12741 MIRAMAR PKWY STE 302
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33027-2905
Mailing Address - Country:US
Mailing Address - Phone:954-602-9723
Mailing Address - Fax:954-602-9724
Practice Address - Street 1:12741 MIRAMAR PKWY STE 302
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33027-2905
Practice Address - Country:US
Practice Address - Phone:954-602-9723
Practice Address - Fax:954-602-9724
Is Sole Proprietor?:No
Enumeration Date:2020-01-06
Last Update Date:2020-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11004709363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily