Provider Demographics
NPI:1821312745
Name:COMPANION, DENISE MALIA LOCK (APRN)
Entity Type:Individual
Prefix:MRS
First Name:DENISE
Middle Name:MALIA LOCK
Last Name:COMPANION
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MS
Other - First Name:DENISE
Other - Middle Name:MALIA
Other - Last Name:LOCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:10140 CENTURION PKWY N
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-0532
Mailing Address - Country:US
Mailing Address - Phone:904-697-4100
Mailing Address - Fax:904-697-5102
Practice Address - Street 1:400 CELEBRATION PL
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34747-4970
Practice Address - Country:US
Practice Address - Phone:407-303-2528
Practice Address - Fax:407-303-2760
Is Sole Proprietor?:No
Enumeration Date:2010-03-22
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIAPRN-1263363LN0000X
FLAPRN11000871363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal