Provider Demographics
NPI:1639069248
Name:GIDDARIE, MARIA (FNP-BC)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:GIDDARIE
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3959 VAN DYKE RD # 241
Mailing Address - Street 2:
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33558-8025
Mailing Address - Country:US
Mailing Address - Phone:678-467-3703
Mailing Address - Fax:
Practice Address - Street 1:3959 VAN DYKE RD # 241
Practice Address - Street 2:
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33558-8025
Practice Address - Country:US
Practice Address - Phone:678-467-3703
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-07
Last Update Date:2025-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11040646363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily