Healthcare Provider Details

I. General information

NPI: 1730514191
Provider Name (Legal Business Name): PENNE PERRY DRAKE DNP, NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: PENNE S PERRY DNP, NP

II. Dates (important events)

Enumeration Date: 09/04/2013
Last Update Date: 01/04/2024
Certification Date: 01/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 E ROLLINS ST
ORLANDO FL
32803-1248
US

IV. Provider business mailing address

601 E ROLLINS ST
ORLANDO FL
32803-1248
US

V. Phone/Fax

Practice location:
  • Phone: 407-975-0410
  • Fax:
Mailing address:
  • Phone: 407-975-0410
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number0024174843
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number17921
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number17921
License Number StateTN
# 4
Primary TaxonomyY
Taxonomy Code363LP0222X
TaxonomyCritical Care Pediatric Nurse Practitioner
License NumberAPRN11006288
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: