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General NPI Number Information
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NPI Number | 1659107100
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Entity Type | Individual
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Provider Name | RENEE DENISE BUCHANAN
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Gender | Female
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Dates
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Enumeration Date | 09/11/2024
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Last Update Date | 10/11/2024
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Provider Practice Location Address
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Address Line | 525 TECHNOLOGY PARK STE 109
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City | LAKE MARY
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State | FL
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Zip | 32746-7107
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Country | US
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Telephone | 407-647-2346
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Fax |
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Provider Business Mailing Address
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Address Line | 15416 AVERY RD
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City | PORT CHARLOTTE
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State | FL
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Zip | 33981-3225
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Country | US
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Telephone | 954-817-6757
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | APRN11035830
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License Number State | FL
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