Individual
MR. NINO ANTHONY FAJARDO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
AGACNP-BC
Contact information
Practice address
24323 PAINTER DR, LAND O LAKES, FL 34639-5459
(863) 409-8812
Mailing address
PO BOX 917770, ORLANDO, FL 32891-0001
(813) 821-8038
(813) 974-0483
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
11014439
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
114149900
—
FL
01
—
2B2SJ
BCBS
FL
Enumeration date
04/10/2022
Last updated
09/05/2023
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