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General NPI Number Information
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NPI Number | 1184255986
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Entity Type | Organization
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Legal Business Name | LAKE NONA INPATIENT SERVICES LLC
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Dates
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Enumeration Date | 01/30/2020
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Last Update Date | 11/19/2020
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Provider Practice Location Address
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Address Line | 6850 LAKE NONA BLVD
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City | ORLANDO
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State | FL
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Zip | 32827-7408
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Country | US
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Telephone | 407-266-1000
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Fax |
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Provider Business Mailing Address
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Address Line | 5380 TECH DATA DR STE 101
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City | CLEARWATER
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State | FL
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Zip | 33760-3122
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Country | US
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Telephone | 469-613-8343
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Fax |
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Authorized Official
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Title or Position | OFFICER
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Name | KATHLEEN KONDAS
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Credential |
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Telephone | 973-251-1132
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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