Healthcare Provider Details

I. General information

NPI: 1396605507
Provider Name (Legal Business Name): LAKE NONA SURGERY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/12/2025
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6424 ALEXANDRA LOUISE DR STE 400
ORLANDO FL
32827-5810
US

IV. Provider business mailing address

6424 ALEXANDRA LOUISE DR STE 400
ORLANDO FL
32827-5810
US

V. Phone/Fax

Practice location:
  • Phone: 407-610-6648
  • Fax: 855-719-2579
Mailing address:
  • Phone: 407-610-6648
  • Fax: 855-719-2579

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. REY ESTEVAN
Title or Position: MGR
Credential:
Phone: 352-622-4251