Provider Demographics
NPI:1295599975
Name:ALLEN, SEAN
Entity type:Individual
Prefix:
First Name:SEAN
Middle Name:
Last Name:ALLEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3354 HANGING TIDE ST
Mailing Address - Street 2:
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-9092
Mailing Address - Country:US
Mailing Address - Phone:850-559-6201
Mailing Address - Fax:
Practice Address - Street 1:685 PALM SPRINGS DRIVE STE 2A
Practice Address - Street 2:
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32701-7853
Practice Address - Country:US
Practice Address - Phone:407-830-5577
Practice Address - Fax:407-830-4164
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-12
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11031086363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontologyGroup - Multi-Specialty