Provider Demographics
NPI:1912764564
Name:ORLANDO, LEANNE
Entity type:Individual
Prefix:
First Name:LEANNE
Middle Name:
Last Name:ORLANDO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6617 WALNUTWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21212-1214
Mailing Address - Country:US
Mailing Address - Phone:410-925-3743
Mailing Address - Fax:
Practice Address - Street 1:1602 OAKFIELD DR STE 205
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-0827
Practice Address - Country:US
Practice Address - Phone:813-655-6367
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-29
Last Update Date:2024-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11031310363LP0808X
MDR231154363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health