Provider Demographics
NPI:1568558302
Name:PRINCE, LOURDES ELENA (ARNP)
Entity Type:Individual
Prefix:
First Name:LOURDES
Middle Name:ELENA
Last Name:PRINCE
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:LOURDES
Other - Middle Name:ELENA
Other - Last Name:QUINONES-BURKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:83 W MILLER ST
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-2028
Mailing Address - Country:US
Mailing Address - Phone:321-841-5281
Mailing Address - Fax:407-648-9879
Practice Address - Street 1:83 W MILLER ST
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-2028
Practice Address - Country:US
Practice Address - Phone:321-841-5281
Practice Address - Fax:407-648-9879
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2016-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1738622363L00000X, 363LW0102X, 367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL300688300Medicaid
FLARNP1738622OtherMEDICAL LICENSE
FLARNP1738622OtherMEDICAL LICENSE
FLU0740YMedicare PIN
FLU0740ZMedicare Oscar/Certification