Provider Demographics
NPI:1679528566
Name:LANKS, LEESA SUZANNE (APRN)
Entity Type:Individual
Prefix:
First Name:LEESA
Middle Name:SUZANNE
Last Name:LANKS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:LEE
Other - Middle Name:SUZANNE
Other - Last Name:COX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:2415 N ORANGE AVE STE 700
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32804-5521
Mailing Address - Country:US
Mailing Address - Phone:407-303-2474
Mailing Address - Fax:407-303-0680
Practice Address - Street 1:2415 N ORANGE AVE STE 700
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804-5521
Practice Address - Country:US
Practice Address - Phone:407-303-2474
Practice Address - Fax:407-303-0680
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9299653363L00000X
LAAP06124363L00000X
MDR118899363L00000X, 363LC0200X
FLAPRN11015673363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LC0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2118617Medicaid
MD619422-01OtherBLUE CROSS/BLUE SHIELD
DC037138800Medicaid
MD510025900Medicaid
MD500025987Medicare PIN
MD619422-01OtherBLUE CROSS/BLUE SHIELD
MDE726Medicare PIN