Provider Demographics
NPI:1861090854
Name:POLANCO, ANA MARIA (NP-C)
Entity type:Individual
Prefix:
First Name:ANA
Middle Name:MARIA
Last Name:POLANCO
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:ANA
Other - Middle Name:MARIA
Other - Last Name:POLANCO GONZALEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:7937 HAMPTON LAKE DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647-3662
Mailing Address - Country:US
Mailing Address - Phone:813-389-9516
Mailing Address - Fax:
Practice Address - Street 1:10575 68TH AVE STE A2
Practice Address - Street 2:
Practice Address - City:SEMINOLE
Practice Address - State:FL
Practice Address - Zip Code:33772-6023
Practice Address - Country:US
Practice Address - Phone:813-389-9516
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-13
Last Update Date:2021-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9348748163W00000X
FLAPRN11009778363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No163W00000XNursing Service ProvidersRegistered Nurse