Provider Demographics
NPI:1003049990
Name:SOTO, ADELENE (ARNP)
Entity Type:Individual
Prefix:
First Name:ADELENE
Middle Name:
Last Name:SOTO
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3372 TUMBLING RIVER DR
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-8907
Mailing Address - Country:US
Mailing Address - Phone:407-467-5947
Mailing Address - Fax:
Practice Address - Street 1:930 MARCUM RD
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33809-4308
Practice Address - Country:US
Practice Address - Phone:863-815-3775
Practice Address - Fax:863-815-3765
Is Sole Proprietor?:No
Enumeration Date:2009-08-26
Last Update Date:2009-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9229185363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics