Provider Demographics
NPI:1477906782
Name:LEE, ADRAIN YVETTE (NP)
Entity Type:Individual
Prefix:
First Name:ADRAIN
Middle Name:YVETTE
Last Name:LEE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6388 SILVER STAR RD STE 2B
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32818-3235
Mailing Address - Country:US
Mailing Address - Phone:407-299-3166
Mailing Address - Fax:407-299-3172
Practice Address - Street 1:6388 SILVER STAR RD STE 2B
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32818
Practice Address - Country:US
Practice Address - Phone:407-299-3166
Practice Address - Fax:407-299-3172
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-21
Last Update Date:2019-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP8854363LF0000X
FLARNP 9244812363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL100004200Medicaid