NPIMap

Organization Active NPI

Primecare Lake Nona, LLC

  • Family Medicine Physician
  • Orlando, FL
National Provider Identifier
1205128642
Registry record updated Jun 20, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
ME36463 Issued in FL
Legal business name
PRIMECARE LAKE NONA, LLC
Practice address
10437 Moss Park Rd
Orlando, FL 32832-5812
Phone
(407) 846-8180
Fax
(407) 347-4858
NPI assigned
May 4, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 20, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ms. Jaime Daniels
Title
Ceo
Phone
(407) 846-8180

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X ME36463 FL Primary
Primary Care Clinic/Center 261QP2300X

Addresses

Primary practice location

10437 Moss Park Rd
Orlando, FL 32832-5812

Mailing address

222 Broadway
Suite 302
Kissimmee, FL 34741
Phone (407) 846-8180

National Provider Directory

National Provider Directory

Locations

222 Broadway
Unit 302
Kissimmee, FL 34741
Phone (407) 846-8180

10437 Moss Park Rd
Orlando, FL 32832
Phone (404) 802-1100

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1304467200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1529452800000",
    "number": "1205128642",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "222 BROADWAY",
            "address_2": "SUITE 302",
            "city": "KISSIMMEE",
            "state": "FL",
            "postal_code": "34741",
            "telephone_number": "407-846-8180",
            "fax_number": "407-347-4858"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10437 MOSS PARK RD",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328325812",
            "telephone_number": "407-846-8180",
            "fax_number": "407-347-4858"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIMECARE LAKE NONA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-05-04",
        "last_updated": "2018-06-20",
        "status": "A",
        "authorized_official_last_name": "DANIELS",
        "authorized_official_first_name": "JAIME",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "407-846-8180",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "ME36463",
            "primary": true
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Orlando, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.