Provider Demographics
NPI:1396914784
Name:BLAISE, LORRIEL SIRENA (NP-C)
Entity type:Individual
Prefix:MRS
First Name:LORRIEL
Middle Name:SIRENA
Last Name:BLAISE
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2723 MAGUIRE RD
Mailing Address - Street 2:
Mailing Address - City:OCOEE
Mailing Address - State:FL
Mailing Address - Zip Code:34761-4797
Mailing Address - Country:US
Mailing Address - Phone:407-877-7003
Mailing Address - Fax:
Practice Address - Street 1:2723 MAGUIRE RD
Practice Address - Street 2:
Practice Address - City:OCOEE
Practice Address - State:FL
Practice Address - Zip Code:34761-4797
Practice Address - Country:US
Practice Address - Phone:407-877-7003
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-29
Last Update Date:2014-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 9179953363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily