Provider Demographics
NPI:1760991756
Name:KURODA, JUSTINE (ARNP, CRNP)
Entity Type:Individual
Prefix:
First Name:JUSTINE
Middle Name:
Last Name:KURODA
Suffix:
Gender:F
Credentials:ARNP, CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6277 SEA HARBOR DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32821-8027
Mailing Address - Country:US
Mailing Address - Phone:689-210-0520
Mailing Address - Fax:833-918-2164
Practice Address - Street 1:6277 SEA HARBOR DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32821-8027
Practice Address - Country:US
Practice Address - Phone:689-210-0520
Practice Address - Fax:833-918-2164
Is Sole Proprietor?:No
Enumeration Date:2017-09-22
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN-503390-L163WP2201X
PASP018031363LF0000X
FL11006944363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care