Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LA2100X | Nurse Practitioner - Acute Care | APRN11006058 | FL |
Y | 363LF0000X | Nurse Practitioner - Family Medicine | APRN11006058 | FL |
NPI | 1023644192 |
---|---|
Provider Name | Nora Lee Vandenbrink |
First Address | Lake Mary, FL 32746-3932 |
Second Address | Orlando, FL 32804-4648 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/03/2020 |
Last Update Date | 08/05/2020 |