Provider Demographics
NPI:1942314661
Name:FLAHERTY, PAMELA LYNN (ARNP)
Entity Type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:LYNN
Last Name:FLAHERTY
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:PAMELA
Other - Middle Name:LYNN
Other - Last Name:TRACY/DIZNEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1120 CITRUS OAKS RUN
Mailing Address - Street 2:
Mailing Address - City:WINTER SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32708-4800
Mailing Address - Country:US
Mailing Address - Phone:407-716-6443
Mailing Address - Fax:407-359-1217
Practice Address - Street 1:150 AMIDON LN
Practice Address - Street 2:WALKER FAMILY SERVICE CENTER
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32809
Practice Address - Country:US
Practice Address - Phone:407-850-5100
Practice Address - Fax:407-850-5141
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1027292363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL3058409-00Medicaid