Provider Demographics
NPI:1083330856
Name:KOEHNLEIN, MEREDITH ALLEN (APRN)
Entity Type:Individual
Prefix:
First Name:MEREDITH
Middle Name:ALLEN
Last Name:KOEHNLEIN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:MEREDITH
Other - Middle Name:FRANCIS
Other - Last Name:ALLEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1400 S ORANGE AVE
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-2134
Mailing Address - Country:US
Mailing Address - Phone:321-648-3800
Mailing Address - Fax:407-425-5203
Practice Address - Street 1:1400 S ORANGE AVE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-2134
Practice Address - Country:US
Practice Address - Phone:321-648-3800
Practice Address - Fax:407-425-5203
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-13
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11022922363LA2200X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health