Provider Demographics
NPI:1093788341
Name:NANDRA FAMILY PHYSICIANS LLC
Entity Type:Organization
Organization Name:NANDRA FAMILY PHYSICIANS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:HARMINDER
Authorized Official - Middle Name:K
Authorized Official - Last Name:NANDRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-921-2074
Mailing Address - Street 1:PO BOX 952739
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32795-2739
Mailing Address - Country:US
Mailing Address - Phone:407-921-2074
Mailing Address - Fax:321-363-1735
Practice Address - Street 1:5840 W COLONIAL DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32808-7558
Practice Address - Country:US
Practice Address - Phone:407-292-2200
Practice Address - Fax:407-292-8210
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-08
Last Update Date:2009-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME85696207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL265823200Medicaid
FL85696Medicare PIN
FL265823200Medicaid