MEDICARE: MR. WILLIE L HERRING

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	11046683	FL

General Provider Information

NPI Number	:	1740123116
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. WILLIE L HERRING

Provider Business Mailing Address
First Line	:	12407 SUMTER DR
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32824-7378
Country	:	US
Telephone Number	:	904-505-6582
Fax Number	:

Provider Business Practice Location Address
First Line	:	12407 SUMTER DR
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32824-7378
Country	:	US
Telephone Number	:	904-505-6582
Fax Number	:

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

Provider Enumeration Date	:	04/10/2026
Last Update Date	:	04/10/2026

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Directions to “ MR. WILLIE L HERRING ” Practice Location

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