NPI 1174719082

Lake Mary Family Physicians P.A.

Organisation Exclusive Provider Organization Lake Mary, FL

Practice location

Address: 910 Williston Park PT Suite 2050, Lake Mary, FL 32746-2172
Phone: (407) 829-8960
Fax: (407) 829-8978

Authorised official

Name: Leah M Sutphin
Title: Billing Manager
Phone: (407) 829-8960

Registered specialties (2)

Exclusive Provider Organization Primary

Managed Care Organizations Taxonomy 302F00000X Licence ME88467, ME88578 (FL)

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Nurse Practitioner

Physician Assistants & Advanced Practice Nursing Providers Taxonomy 363L00000X Licence ARNP1103432 (FL)

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Registry record

NPI: 1174719082
Entity type: Organization
NPI issued: 25 Sep 2007
Record last updated: 7 Jul 2009

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.