Healthcare Provider Details

I. General information

NPI: 1538591888
Provider Name (Legal Business Name): DEANNA L KOENEN ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2013
Last Update Date: 06/11/2025
Certification Date: 06/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1735 E HWY 50 STE B
CLERMONT FL
34711-5189
US

IV. Provider business mailing address

6101 BLUE LAGOON DR STE 200
MIAMI FL
33126-3168
US

V. Phone/Fax

Practice location:
  • Phone: 352-241-0549
  • Fax: 352-242-9325
Mailing address:
  • Phone: 305-500-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number9167881
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: