Healthcare Provider Details

I. General information

NPI: 1467191478
Provider Name (Legal Business Name): ALIANA BORNMANN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALIANA STITZEL

II. Dates (important events)

Enumeration Date: 05/31/2022
Last Update Date: 05/16/2024
Certification Date: 05/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3240 S FLORIDA AVE # 105
LAKELAND FL
33803-4574
US

IV. Provider business mailing address

425 W COLONIAL DR STE 303
ORLANDO FL
32804-6863
US

V. Phone/Fax

Practice location:
  • Phone: 863-646-4000
  • Fax:
Mailing address:
  • Phone: 321-332-6947
  • Fax: 407-286-4515

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number11019950
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: