MEDICARE: MS. LASANDRA MONIQUE LEE APRN, FNP-C

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	163W00000X	Registered Nurse	RN9330592	FL
2	363LF0000X	Family Nurse Practitioner	11033256	FL

General Provider Information

NPI Number	:	1992447452
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LASANDRA MONIQUE LEE APRN, FNP-C

Provider Business Mailing Address
First Line	:	361 LAKEBREEZE CIRCLE
Second Line	:
City	:	LAKE MARY
State	:	FL
Zip	:	32746-6057
Country	:	US
Telephone Number	:	561-598-9609
Fax Number	:

Provider Business Practice Location Address
First Line	:	1317 EDGEWATER DRIVE
Second Line	:	SUITE 2761
City	:	ORLANDO
State	:	FL
Zip	:	32804
Country	:	US
Telephone Number	:	561-598-9609
Fax Number	:

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

Provider Enumeration Date	:	04/13/2022
Last Update Date	:	06/28/2024

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