Healthcare Provider Details

I. General information

NPI: 1932513389
Provider Name (Legal Business Name): LATEISHA GILZEAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2014
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3099 ORANGE CENTER BLVD
ORLANDO FL
32805-4362
US

IV. Provider business mailing address

2314 PESARO CIR
OCOEE FL
34761-5005
US

V. Phone/Fax

Practice location:
  • Phone: 407-601-0491
  • Fax: 407-395-3487
Mailing address:
  • Phone: 407-601-0491
  • Fax: 407-395-3487

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-17-26697
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: