Provider Demographics
NPI:1326545732
Name:NEAL, ADRIENNA D
Entity Type:Individual
Prefix:
First Name:ADRIENNA
Middle Name:D
Last Name:NEAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 580654
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32858-0654
Mailing Address - Country:US
Mailing Address - Phone:407-625-8504
Mailing Address - Fax:
Practice Address - Street 1:909 BORDEAUX PL
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32808-7734
Practice Address - Country:US
Practice Address - Phone:407-625-8504
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-11
Last Update Date:2020-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9490120163WC1500X
172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
No172V00000XOther Service ProvidersCommunity Health Worker