Healthcare Provider Details

I. General information

NPI: 1740123116
Provider Name (Legal Business Name): MR. WILLIE L HERRING
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2026
Last Update Date: 04/10/2026
Certification Date: 04/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12407 SUMTER DR
ORLANDO FL
32824-7378
US

IV. Provider business mailing address

12407 SUMTER DR
ORLANDO FL
32824-7378
US

V. Phone/Fax

Practice location:
  • Phone: 904-505-6582
  • Fax:
Mailing address:
  • Phone: 904-505-6582
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number11046683
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: