Healthcare Provider Details

I. General information

NPI: 1841126745
Provider Name (Legal Business Name): MICHAEL LUE WARNER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2026
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11476 S APOPKA VINELAND RD # 118
ORLANDO FL
32836-7006
US

IV. Provider business mailing address

300 INTERNATIONAL PKWY STE 200
LAKE MARY FL
32746-5028
US

V. Phone/Fax

Practice location:
  • Phone: 407-955-4001
  • Fax:
Mailing address:
  • Phone: 407-915-7729
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberW636962085000
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: