Basic Information
Provider Information
NPI: 1184225112
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: STRONG
FirstName: DANTE
MiddleName: LAMAR
NamePrefix: MR.
NameSuffix:  
Credential: APRN
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2501 N ORANGE AVE STE 401
Address2:  
City: ORLANDO
State: FL
PostalCode: 328044644
CountryCode: US
TelephoneNumber: 4073037283
FaxNumber:  
Practice Location
Address1: 601 E ROLLINS ST
Address2:  
City: ORLANDO
State: FL
PostalCode: 328031248
CountryCode: US
TelephoneNumber: 4073037283
FaxNumber:  
Other Information
ProviderEnumerationDate: 11/05/2020
LastUpdateDate: 08/26/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 08/26/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LA2100XAPRN11009895FLY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
363LG0600XAPRN11009895FLN Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology

No ID Information.


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