Provider Demographics
NPI:1447905104
Name:HUNTINGTON, LUNIE (APRN)
Entity type:Individual
Prefix:
First Name:LUNIE
Middle Name:
Last Name:HUNTINGTON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 MARK DAVID BLVD
Mailing Address - Street 2:
Mailing Address - City:CASSELBERRY
Mailing Address - State:FL
Mailing Address - Zip Code:32707-5417
Mailing Address - Country:US
Mailing Address - Phone:407-267-2369
Mailing Address - Fax:
Practice Address - Street 1:5151 RALEIGH ST STE B
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32811-3926
Practice Address - Country:US
Practice Address - Phone:407-858-1487
Practice Address - Fax:407-858-4639
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-21
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11010572364SF0001X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL113450100Medicaid