Lake Mary Family Physicians P.A.
Exclusive Provider Organization in Lake Mary, FL. Organization (NPI-2).
NPI number1174719082
StatusActive
Last updated in NPPESJul 7, 2009
Details
- NPI
- 1174719082
- Entity type
- Organization (NPI-2)
- Legal business name
- Lake Mary Family Physicians P.A.
- Organization subpart
- No
- Enumeration date
- Sep 25, 2007
- Last updated
- Jul 7, 2009
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 302F00000X | Exclusive Provider Organization | me88467, me88578 | FL | Yes |
| 363L00000X | Nurse Practitioner | ARNP1103432 | FL |
Practice location
910 Williston Park PtSuite 2050
Lake Mary, FL 32746-2172
Phone 407-829-8960 · Fax 407-829-8978
Mailing address
910 Williston Park PtSuite 2050
Lake Mary, FL 32746-2172
Phone 407-829-8960 · Fax 407-829-8978
Authorized official
Leah M Sutphin
Billing Manager
4078298960
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