Healthcare Provider Details

I. General information

NPI: 1821363078
Provider Name (Legal Business Name): AUTUMN NIKOLE MCINERNEY APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AUTUMN NIKOLE NORTON APRN

II. Dates (important events)

Enumeration Date: 03/20/2012
Last Update Date: 11/25/2024
Certification Date: 11/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

86 W UNDERWOOD ST
ORLANDO FL
32806-1110
US

IV. Provider business mailing address

86 W UNDERWOOD ST
ORLANDO FL
32806-1110
US

V. Phone/Fax

Practice location:
  • Phone: 321-843-5270
  • Fax: 321-843-5177
Mailing address:
  • Phone: 321-843-5270
  • Fax: 321-843-5177

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License NumberAPRN9226966
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberCOA.13226-NP
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberCOA.13226-NP
License Number StateOH
# 4
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberARNP9226966
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: