=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841012580
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LANTERNA GROUP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/24/2024
-----------------------------------------------------
Last Update Date | 11/05/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5401 S KIRKMAN RD STE 300
-----------------------------------------------------
City | ORLANDO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32819-7937
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-519-2139
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5401 S KIRKMAN RD STE 300
-----------------------------------------------------
City | ORLANDO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32819-7937
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-519-2139
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MS. ROSA NAPOLES
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 407-519-2139
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------