Provider Demographics
NPI:1972059442
Name:MCCORMICK, TALANDA (ARNP)
Entity Type:Individual
Prefix:
First Name:TALANDA
Middle Name:
Last Name:MCCORMICK
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3160 SOUTHGATE COMMERCE BLVD STE 64
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-8551
Mailing Address - Country:US
Mailing Address - Phone:407-857-8860
Mailing Address - Fax:407-857-7099
Practice Address - Street 1:3160 SOUTHGATE COMMERCE BLVD STE 64
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-8551
Practice Address - Country:US
Practice Address - Phone:407-857-8860
Practice Address - Fax:407-857-7099
Is Sole Proprietor?:No
Enumeration Date:2016-08-25
Last Update Date:2018-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9243680363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily