Provider Demographics
NPI:1447426234
Name:LANDERS, JUANITA L (MSN, FNP, CRNP)
Entity Type:Individual
Prefix:MRS
First Name:JUANITA
Middle Name:L
Last Name:LANDERS
Suffix:
Gender:F
Credentials:MSN, FNP, CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12280 LAKE UNDERHILL RD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32825-5009
Mailing Address - Country:US
Mailing Address - Phone:866-389-2727
Mailing Address - Fax:401-652-9787
Practice Address - Street 1:12280 LAKE UNDERHILL RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32825-5009
Practice Address - Country:US
Practice Address - Phone:866-389-2727
Practice Address - Fax:401-652-9787
Is Sole Proprietor?:No
Enumeration Date:2008-05-01
Last Update Date:2011-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL0151480363LF0000X
FL9331197363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP14686Medicare UPIN
ALP14686Medicare UPIN