Healthcare Provider Details

I. General information

NPI: 1538605266
Provider Name (Legal Business Name): ILIANA E MASTRAPA COROMINAS ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2017
Last Update Date: 04/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5979 VINELAND RD
ORLANDO FL
32819-7800
US

IV. Provider business mailing address

121 S ORANGE AVE STE 940
ORLANDO FL
32801-3234
US

V. Phone/Fax

Practice location:
  • Phone: 407-627-0066
  • Fax: 407-440-4054
Mailing address:
  • Phone: 407-658-9687
  • Fax: 407-286-4515

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberARNP9440067
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: