Healthcare Provider Details

I. General information

NPI: 1104132018
Provider Name (Legal Business Name): LINDSEY LEIGH GRANGER ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LINDSEY LEIGH GAVIN-GARN

II. Dates (important events)

Enumeration Date: 08/30/2010
Last Update Date: 09/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13535 NEMOURS PARKWAY NEMOURS CHILDRENS HOSPITAL,
ORLANDO FL
32827-7402
US

IV. Provider business mailing address

P.O. BOX 191 PROVIDER ENROLLMENT DEPARTMENT,
ROCKLAND DE
19732-0191
US

V. Phone/Fax

Practice location:
  • Phone: 407-567-4000
  • Fax: 407-650-7277
Mailing address:
  • Phone: 302-298-7371
  • Fax: 302-651-4945

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberARNP9268813
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberARNP9407864
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: