Provider Demographics
NPI:1710968003
Name:IACONO, KAREN LYNN (APRN)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:LYNN
Last Name:IACONO
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2501 N ORANGE AVE STE 310
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32804-4642
Mailing Address - Country:US
Mailing Address - Phone:407-303-2001
Mailing Address - Fax:407-303-2450
Practice Address - Street 1:2501 N ORANGE AVE STE 310
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804-4642
Practice Address - Country:US
Practice Address - Phone:407-303-2001
Practice Address - Fax:407-303-2450
Is Sole Proprietor?:No
Enumeration Date:2005-11-14
Last Update Date:2019-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF381037363LP0200X
FLARNP9234709363LP0200X
FLAPRN9234709363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL307170700Medicaid
FLARNP9234709OtherMEDICAL LICENSE
FLARNP9234709OtherMEDICAL LICENSE