Provider Demographics
NPI:1275180200
Name:GREEN, JANISH LEE (FNP)
Entity Type:Individual
Prefix:
First Name:JANISH
Middle Name:LEE
Last Name:GREEN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10701 INTERNATIONAL DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32821-7392
Mailing Address - Country:US
Mailing Address - Phone:407-355-0929
Mailing Address - Fax:
Practice Address - Street 1:10701 INTERNATIONAL DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32821-7392
Practice Address - Country:US
Practice Address - Phone:407-355-0929
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-23
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11011986363LF0000X
VA0024178370363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAMG6038219OtherDEA NUMBER