Provider Demographics
NPI:1205462256
Name:LONDONO, LINDSEY ANN (APRN)
Entity type:Individual
Prefix:
First Name:LINDSEY
Middle Name:ANN
Last Name:LONDONO
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1063 ROBERTS ST
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-3318
Mailing Address - Country:US
Mailing Address - Phone:386-675-5006
Mailing Address - Fax:
Practice Address - Street 1:1063 ROBERTS ST
Practice Address - Street 2:
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-3318
Practice Address - Country:US
Practice Address - Phone:386-675-5006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-20
Last Update Date:2020-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11005595363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner