Healthcare Provider Details

I. General information

NPI: 1235862178
Provider Name (Legal Business Name): SUMMER LEIGH ALLEN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2022
Last Update Date: 07/07/2022
Certification Date: 07/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

251 MAITLAND AVE STE 116
ALTAMONTE SPRINGS FL
32701-4913
US

IV. Provider business mailing address

PO BOX 940145
MAITLAND FL
32794-0145
US

V. Phone/Fax

Practice location:
  • Phone: 407-915-5643
  • Fax: 407-915-5643
Mailing address:
  • Phone: 407-915-9643
  • Fax: 407-960-2602

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11020373
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: