Healthcare Provider Details

I. General information

NPI: 1396914784
Provider Name (Legal Business Name): LORRIEL SIRENA BLAISE NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/29/2008
Last Update Date: 01/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2723 MAGUIRE RD
OCOEE FL
34761-4797
US

IV. Provider business mailing address

2723 MAGUIRE RD
OCOEE FL
34761-4797
US

V. Phone/Fax

Practice location:
  • Phone: 407-877-7003
  • Fax:
Mailing address:
  • Phone: 407-877-7003
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP 9179953
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: