Provider Demographics
NPI:1205549573
Name:LAMOTHE, MIRLINE (MSN, APRN, PMHNP)
Entity type:Individual
Prefix:
First Name:MIRLINE
Middle Name:
Last Name:LAMOTHE
Suffix:
Gender:F
Credentials:MSN, APRN, PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5222 ANDRUS AVE STE C
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32810-5456
Mailing Address - Country:US
Mailing Address - Phone:407-745-5022
Mailing Address - Fax:
Practice Address - Street 1:5222 ANDRUS AVE STE C
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32810-5456
Practice Address - Country:US
Practice Address - Phone:407-745-5022
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-03
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11022903363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health