Healthcare Provider Details

I. General information

NPI: 1740123116
Provider Name (Legal Business Name): WILLIE L HERRING PMHNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2026
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2910 MAGUIRE RD STE 2002
OCOEE FL
34761-4742
US

IV. Provider business mailing address

2910 MAGUIRE RD STE 2002
OCOEE FL
34761-4742
US

V. Phone/Fax

Practice location:
  • Phone: 407-287-1664
  • Fax: 407-287-1675
Mailing address:
  • Phone: 407-287-1664
  • Fax: 407-287-1675

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN11046683
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: