Provider Demographics
NPI:1477279255
Name:DEMA, MAYA (APRN)
Entity Type:Individual
Prefix:
First Name:MAYA
Middle Name:
Last Name:DEMA
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:392 RINEHART RD
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-2527
Mailing Address - Country:US
Mailing Address - Phone:321-842-2800
Mailing Address - Fax:321-842-2370
Practice Address - Street 1:392 RINEHART RD
Practice Address - Street 2:
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-2527
Practice Address - Country:US
Practice Address - Phone:321-842-2800
Practice Address - Fax:321-842-2370
Is Sole Proprietor?:No
Enumeration Date:2022-10-13
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11022390363LA2200X
FL11022390363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health