Provider Demographics
NPI:1720785702
Name:STEMPLES, LANCE ROBERT
Entity Type:Individual
Prefix:
First Name:LANCE
Middle Name:ROBERT
Last Name:STEMPLES
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 1:303 E PAR ST
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32804-4003
Mailing Address - Country:US
Mailing Address - Phone:321-841-9360
Mailing Address - Fax:321-843-4101
Practice Address - Street 1:303 E PAR ST
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804-4003
Practice Address - Country:US
Practice Address - Phone:321-841-9360
Practice Address - Fax:321-843-4101
Is Sole Proprietor?:No
Enumeration Date:2023-02-10
Last Update Date:2023-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
FLPA9117187363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant