Healthcare Provider Details

I. General information

NPI: 1144136854
Provider Name (Legal Business Name): WANDALIE DORVIL PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2026
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6220 S ORANGE BLOSSOM TRL STE 138
ORLANDO FL
32809-4683
US

IV. Provider business mailing address

6220 S ORANGE BLOSSOM TRL STE 138
ORLANDO FL
32809-4683
US

V. Phone/Fax

Practice location:
  • Phone: 954-200-1187
  • Fax:
Mailing address:
  • Phone: 954-200-1187
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberC-APN.0107578-C-NP
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN11050321
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: