Healthcare Provider Details

I. General information

NPI: 1710248240
Provider Name (Legal Business Name): LASHAWNA PERRY ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/31/2012
Last Update Date: 05/31/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 N WYMORE RD SUITE 102
WINTER PARK FL
32789-2859
US

IV. Provider business mailing address

650 N WYMORE RD SUITE 102
WINTER PARK FL
32789-2859
US

V. Phone/Fax

Practice location:
  • Phone: 407-644-9040
  • Fax: 407-644-9004
Mailing address:
  • Phone: 407-644-9040
  • Fax: 407-644-9004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberARNP9233755
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: