Provider Demographics
NPI:1508920786
Name:SORENSEN, GEORGIANNA WALKER (ARNP LMHC PHD)
Entity Type:Individual
Prefix:DR
First Name:GEORGIANNA
Middle Name:WALKER
Last Name:SORENSEN
Suffix:
Gender:F
Credentials:ARNP LMHC PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:237 E PARK AVE
Mailing Address - Street 2:
Mailing Address - City:LAKE WALES
Mailing Address - State:FL
Mailing Address - Zip Code:33853-3705
Mailing Address - Country:US
Mailing Address - Phone:863-676-4700
Mailing Address - Fax:863-676-4707
Practice Address - Street 1:237 E PARK AVE
Practice Address - Street 2:
Practice Address - City:LAKE WALES
Practice Address - State:FL
Practice Address - Zip Code:33853-3705
Practice Address - Country:US
Practice Address - Phone:863-676-4700
Practice Address - Fax:863-676-4707
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-21
Last Update Date:2015-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH0002775101YM0800X
FL820192363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
Z4905OtherBCBS LMHC
Y4028Medicare ID - Type Unspecified