Provider Demographics
NPI:1144536202
Name:DENMARK, SUMMER
Entity type:Individual
Prefix:MRS
First Name:SUMMER
Middle Name:
Last Name:DENMARK
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 1:17709 STERLING POND LN
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32820-2286
Mailing Address - Country:US
Mailing Address - Phone:407-208-9870
Mailing Address - Fax:407-208-9868
Practice Address - Street 1:815 WOODBURY RD
Practice Address - Street 2:SUITE 102
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32828-4515
Practice Address - Country:US
Practice Address - Phone:407-208-9870
Practice Address - Fax:407-208-9868
Is Sole Proprietor?:No
Enumeration Date:2010-08-27
Last Update Date:2010-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9233639363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics