Healthcare Provider Details

I. General information

NPI: 1831611375
Provider Name (Legal Business Name): D & D PRIMARY CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2017
Last Update Date: 03/07/2025
Certification Date: 03/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

844 N JOHN YOUNG PKWY
KISSIMMEE FL
34741-4912
US

IV. Provider business mailing address

844 N JOHN YOUNG PKWY # A
KISSIMMEE FL
34741-4912
US

V. Phone/Fax

Practice location:
  • Phone: 407-795-7705
  • Fax:
Mailing address:
  • Phone: 407-795-7705
  • Fax: 407-956-8820

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code363LC1500X
TaxonomyCommunity Health Nurse Practitioner
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. DARLENE GORDON
Title or Position: OWNER/CEO/AAPRN/FNP-BC
Credential:
Phone: 407-795-7705