Healthcare Provider Details

I. General information

NPI: 1376278564
Provider Name (Legal Business Name): LA DONNA L LUE WINSTON APRN,ACAGNP, MSN ED.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2022
Last Update Date: 07/21/2022
Certification Date: 07/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5908 SIENA LN
HOLLYWOOD FL
33021-3856
US

IV. Provider business mailing address

5908 SIENA LN
HOLLYWOOD FL
33021-3856
US

V. Phone/Fax

Practice location:
  • Phone: 954-600-0366
  • Fax:
Mailing address:
  • Phone: 754-610-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN11020918
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: