Healthcare Provider Details

I. General information

NPI: 1588915540
Provider Name (Legal Business Name): LINDSI NICCOLE CREEL ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2012
Last Update Date: 11/27/2023
Certification Date: 11/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3160 SOUTHGATE COMMERCE BLVD #64
ORLANDO FL
32806-8549
US

IV. Provider business mailing address

3931 SHOEMAKER CT
MARIETTA GA
30062-6821
US

V. Phone/Fax

Practice location:
  • Phone: 407-857-8860
  • Fax:
Mailing address:
  • Phone: 407-721-0724
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberRN243467
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: