Healthcare Provider Details

I. General information

NPI: 1942314661
Provider Name (Legal Business Name): PAMELA LYNN FLAHERTY ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: PAMELA LYNN TRACY/DIZNEY RN

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 AMIDON LN WALKER FAMILY SERVICE CENTER
ORLANDO FL
32809
US

IV. Provider business mailing address

1120 CITRUS OAKS RUN
WINTER SPRINGS FL
32708-4800
US

V. Phone/Fax

Practice location:
  • Phone: 407-850-5100
  • Fax: 407-850-5141
Mailing address:
  • Phone: 407-716-6443
  • Fax: 407-359-1217

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberARNP1027292
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: