Provider Demographics
NPI:1003475211
Name:PENNY, ALLISON LEIGH (APRN)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:LEIGH
Last Name:PENNY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:ALLISON
Other - Middle Name:LEIGH
Other - Last Name:BOMBALIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:PO BOX 691597
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32869-1597
Mailing Address - Country:US
Mailing Address - Phone:407-898-1210
Mailing Address - Fax:407-898-2909
Practice Address - Street 1:615 E PRINCETON ST STE 510
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-1424
Practice Address - Country:US
Practice Address - Phone:407-898-1210
Practice Address - Fax:407-898-2909
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-11
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9367136363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPC866OtherFL HF MA