Provider Demographics
NPI:1124535505
Name:CALDERON, LENNIE (APRN)
Entity type:Individual
Prefix:MRS
First Name:LENNIE
Middle Name:
Last Name:CALDERON
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 1:400 CELEBRATION PL STE A270
Mailing Address - Street 2:
Mailing Address - City:CELEBRATION
Mailing Address - State:FL
Mailing Address - Zip Code:34747-4970
Mailing Address - Country:US
Mailing Address - Phone:407-303-4078
Mailing Address - Fax:407-303-4083
Practice Address - Street 1:400 CELEBRATION PL STE A270
Practice Address - Street 2:
Practice Address - City:CELEBRATION
Practice Address - State:FL
Practice Address - Zip Code:34747-4970
Practice Address - Country:US
Practice Address - Phone:407-303-4078
Practice Address - Fax:407-303-4083
Is Sole Proprietor?:No
Enumeration Date:2018-01-06
Last Update Date:2021-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9216974363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology