Provider Demographics
NPI:1366690455
Name:STROUD, LELA MAE (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:LELA
Middle Name:MAE
Last Name:STROUD
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2875 LAKE SILVER RD
Mailing Address - Street 2:
Mailing Address - City:CRESTVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:32536-7183
Mailing Address - Country:US
Mailing Address - Phone:850-683-1069
Mailing Address - Fax:
Practice Address - Street 1:2875 LAKE SILVER RD
Practice Address - Street 2:
Practice Address - City:CRESTVIEW
Practice Address - State:FL
Practice Address - Zip Code:32536-7183
Practice Address - Country:US
Practice Address - Phone:850-683-1069
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-03
Last Update Date:2008-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9164083363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner