Provider Demographics
NPI:1699905240
Name:LEMOYNE, VIRGINIA R (ARNP)
Entity type:Individual
Prefix:MRS
First Name:VIRGINIA
Middle Name:R
Last Name:LEMOYNE
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:MS
Other - First Name:VIRGINIA
Other - Middle Name:R
Other - Last Name:PIERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:111 ELIZABETH ST
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32117-1714
Mailing Address - Country:US
Mailing Address - Phone:386-871-7296
Mailing Address - Fax:
Practice Address - Street 1:111 ELIZABETH ST
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32117-1714
Practice Address - Country:US
Practice Address - Phone:386-871-7296
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-16
Last Update Date:2022-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9228444363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL008265700Medicaid