MEDICARE: IMANI NIA ALS LPN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164W00000X	Licensed Practical Nurse	0002096899	VA

General Provider Information

NPI Number	:	1043032196
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IMANI NIA ALS LPN

Provider Business Mailing Address
First Line	:	255 S ORANGE AVE STE 104
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32801-3411
Country	:	US
Telephone Number	:	352-272-6713
Fax Number	:	321-326-1028

Provider Business Practice Location Address
First Line	:	255 S ORANGE AVE STE 104
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32801-3411
Country	:	US
Telephone Number	:	352-272-6713
Fax Number	:	321-326-1028

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/29/2024
Last Update Date	:	10/29/2024

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Directions to “ IMANI NIA ALS LPN” Practice Location

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