Healthcare Provider Details

I. General information

NPI: 1871138628
Provider Name (Legal Business Name): LORRAINE LUCE HENRY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/14/2019
Last Update Date: 02/23/2024
Certification Date: 02/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 CRANES ROOST BLVD STE 1220
ALTAMONTE SPRINGS FL
32701-3480
US

IV. Provider business mailing address

1631 ASTER DR
WINTER PARK FL
32792-6201
US

V. Phone/Fax

Practice location:
  • Phone: 407-774-3325
  • Fax:
Mailing address:
  • Phone: 407-547-6529
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number9436849
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: