Healthcare Provider Details

I. General information

NPI: 1750927257
Provider Name (Legal Business Name): PUTTIDA VORAPIPATANA APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/20/2019
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 W PINELOCH AVE
ORLANDO FL
32806-6100
US

IV. Provider business mailing address

2823 BURWOOD AVE
ORLANDO FL
32837-8542
US

V. Phone/Fax

Practice location:
  • Phone: 407-635-5060
  • Fax:
Mailing address:
  • Phone: 407-579-9010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN9440861
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number3-002992
License Number StateAL
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN11009575
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: