Provider Demographics
NPI:1760989750
Name:ASCHEBROOK, LONNIE HENRY (AP)
Entity Type:Individual
Prefix:
First Name:LONNIE
Middle Name:HENRY
Last Name:ASCHEBROOK
Suffix:
Gender:M
Credentials:AP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9246 REYMONT ST
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32827-3814
Mailing Address - Country:US
Mailing Address - Phone:407-274-3789
Mailing Address - Fax:
Practice Address - Street 1:6900 TAVISTOCK LAKES BLVD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32827-7589
Practice Address - Country:US
Practice Address - Phone:901-376-5198
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-07
Last Update Date:2019-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3933171100000X
FL11004373363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty