Provider Demographics
NPI:1396055950
Name:NUNEZ, ILEANA (ARNP-BC)
Entity type:Individual
Prefix:
First Name:ILEANA
Middle Name:
Last Name:NUNEZ
Suffix:
Gender:F
Credentials:ARNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17327 PAGONIA RD
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-6009
Mailing Address - Country:US
Mailing Address - Phone:407-905-6000
Mailing Address - Fax:407-636-7848
Practice Address - Street 1:17327 PAGONIA RD
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-6009
Practice Address - Country:US
Practice Address - Phone:407-905-6000
Practice Address - Fax:407-636-7848
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-18
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9167482363LF0000X
FLAPRN9167482363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily