Healthcare Provider Details

I. General information

NPI: 1154032332
Provider Name (Legal Business Name): TANYA LUNDINE APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2022
Last Update Date: 12/08/2022
Certification Date: 12/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

92 W MILLER ST
ORLANDO FL
32806-2032
US

IV. Provider business mailing address

901 GROVESMERE LOOP
OCOEE FL
34761-5625
US

V. Phone/Fax

Practice location:
  • Phone: 321-841-6917
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberAPRN11021863
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: