Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | APRN2973652 | FL |
NPI | 1013947027 |
---|---|
Provider Name | Dana K Theisen |
First Address | Clermont, FL 34711-4605 |
Second Address | Orlando, FL 32804-5521 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/07/2006 |
Last Update Date | 09/07/2020 |