Individual provider Active NPI

Kathleen D Lauderback, ARNP

  • Family Nurse Practitioner
  • Apopka, FL
National Provider Identifier
1871779652
Registry record updated Mar 10, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
1611212 Issued in FL
Practice address
515 Wekiva Commons Cir
Apopka, FL 32712-3645
Phone
(407) 464-9516
Fax
(407) 464-9519
NPI assigned
Jan 11, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 10, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 1611212 FL Primary

Addresses

Primary practice location

515 Wekiva Commons Cir
Apopka, FL 32712-3645

Mailing address

515 Wekiva Commons Cir
Apopka, FL 32712-3645
Phone (407) 464-9516

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040928000792 FL Practitioner - Nurse Practitioner 7214906148 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
1611212FLMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Gastroenterology Associate of Central Florida CurrentSince Jul 1, 2004 Accepting new patients

Locations

4106 W Lake Mary Blvd
Ste 201
Lake Mary, FL 32746
Phone (407) 425-1566

601 E Rollins St
Orlando, FL 32803
Phone (407) 303-1996

1817 N Mills Ave
Orlando, FL 32803
Phone (407) 241-3248

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1200009600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1425945600000",
    "number": "1871779652",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "515 WEKIVA COMMONS CIR",
            "city": "APOPKA",
            "state": "FL",
            "postal_code": "327123645",
            "telephone_number": "407-464-9516",
            "fax_number": "407-464-9519"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "515 WEKIVA COMMONS CIR",
            "city": "APOPKA",
            "state": "FL",
            "postal_code": "327123645",
            "telephone_number": "407-464-9516",
            "fax_number": "407-464-9519"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LAUDERBACK",
        "first_name": "KATHLEEN",
        "middle_name": "D",
        "credential": "ARNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-01-11",
        "last_updated": "2015-03-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "FL",
            "license": "1611212",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Apopka, FL

Sources for this page

Verify at the official NPI Registry.