Provider Demographics
NPI:1407017114
Name:CONEY, LAKISHA DENISE (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:LAKISHA
Middle Name:DENISE
Last Name:CONEY
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 1:2900 CORPORATE WAY
Mailing Address - Street 2:DOOR D
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33025
Mailing Address - Country:US
Mailing Address - Phone:954-276-5663
Mailing Address - Fax:954-276-0301
Practice Address - Street 1:1150 N 35TH AVE
Practice Address - Street 2:SUITE 605
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-5424
Practice Address - Country:US
Practice Address - Phone:954-265-7900
Practice Address - Fax:954-276-0252
Is Sole Proprietor?:No
Enumeration Date:2008-06-24
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9203065363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002922300Medicaid
FLEC062ZMedicare PIN