Provider Demographics
NPI:1053784983
Name:LEE, CARMELIA MARIA (NP)
Entity type:Individual
Prefix:MS
First Name:CARMELIA
Middle Name:MARIA
Last Name:LEE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2370 E INTERNATIONAL SPEEDWAY BLVD
Mailing Address - Street 2:
Mailing Address - City:DELAND
Mailing Address - State:FL
Mailing Address - Zip Code:32724-2744
Mailing Address - Country:US
Mailing Address - Phone:386-736-1105
Mailing Address - Fax:386-734-1443
Practice Address - Street 1:2370 E INTERNATIONAL SPEEDWAY BLVD
Practice Address - Street 2:
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32724
Practice Address - Country:US
Practice Address - Phone:386-736-1105
Practice Address - Fax:386-734-1443
Is Sole Proprietor?:No
Enumeration Date:2015-10-30
Last Update Date:2018-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9334523363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily