Provider Demographics
NPI:1477675718
Name:MENZEL, PAMELA LYNN (APRN)
Entity Type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:LYNN
Last Name:MENZEL
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MRS
Other - First Name:PAMELA
Other - Middle Name:L
Other - Last Name:FARR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:1000 W BROADWAY ST STE 205
Mailing Address - Street 2:
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-9262
Mailing Address - Country:US
Mailing Address - Phone:407-706-1650
Mailing Address - Fax:407-706-1651
Practice Address - Street 1:1000 W BROADWAY ST STE 205
Practice Address - Street 2:
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-9262
Practice Address - Country:US
Practice Address - Phone:407-706-1650
Practice Address - Fax:407-706-1651
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2020-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9218749363L00000X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL309144900Medicaid
FLY07ZROtherBCBS FL
FL9218749OtherARNP
FLP00881846OtherRR MEDICARE
FLAK277ZMedicare PIN