Healthcare Provider Details

I. General information

NPI: 1710968003
Provider Name (Legal Business Name): KAREN LYNN IACONO APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2005
Last Update Date: 06/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 N ORANGE AVE STE 310
ORLANDO FL
32804-4642
US

IV. Provider business mailing address

2501 N ORANGE AVE STE 310
ORLANDO FL
32804-4642
US

V. Phone/Fax

Practice location:
  • Phone: 407-303-2001
  • Fax: 407-303-2450
Mailing address:
  • Phone: 407-303-2001
  • Fax: 407-303-2450

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberF381037
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberARNP9234709
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAPRN9234709
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: