Healthcare Provider Details

I. General information

NPI: 1710301445
Provider Name (Legal Business Name): GERLIE ILAG CARDENAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2014
Last Update Date: 06/04/2025
Certification Date: 06/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 HUNTERS CREEK BLVD
ORLANDO FL
32837-6901
US

IV. Provider business mailing address

111 N ORANGE AVE STE 800
ORLANDO FL
32801-2381
US

V. Phone/Fax

Practice location:
  • Phone: 407-857-2502
  • Fax:
Mailing address:
  • Phone: 888-731-8994
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP135978
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF338359
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11036701
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: