Provider Demographics
NPI:1447910062
Name:SPILLIARD, RONDA (FNP-C)
Entity type:Individual
Prefix:
First Name:RONDA
Middle Name:
Last Name:SPILLIARD
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:313 WATER SHORE DR
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34748-7009
Mailing Address - Country:US
Mailing Address - Phone:352-551-7317
Mailing Address - Fax:
Practice Address - Street 1:3631 W BURLEIGH BLVD
Practice Address - Street 2:
Practice Address - City:TAVARES
Practice Address - State:FL
Practice Address - Zip Code:32778-5803
Practice Address - Country:US
Practice Address - Phone:352-742-0025
Practice Address - Fax:352-742-8167
Is Sole Proprietor?:No
Enumeration Date:2021-12-22
Last Update Date:2021-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11017103363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily