Registry details
Type
Individual
Primary specialty
Nurse Practitioner
Enumerated
Dec 14, 2022
License(s)
11023458 (FL), APRN11023458 (FL)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| LOCATION | 1613 N MILLS AVE | Orlando, FL 32803-1849 | 407-894-4474 |
| MAILING | 12486 STONE BARK TRL | Orlando, FL 32824-7373 | 407-271-1355 |
Watch this provider
Get a webhook/email the day this provider is added to the OIG-LEIE exclusion list or appears in an FDA enforcement action.