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Organization
LAKE PEDIATRICS P. A.
Active
Organization
LAKE PEDIATRICS P. A.
Active
Other names
Lake Pediatrics, P.A.
Organization subpart
No
Provider details
NPI number
Authorized official
DONNA LYNN NETTLES (BILLING MANAGER)
(523) 638-4997
Entity
Organization
Contact information
Practice address
4880 N HIGHWAY 19A STE 200, MOUNT DORA, FL 32757-2018
(352) 589-8111
(352) 589-8111
Mailing address
4880 N HWY 19 A, MT DORA, FL 32757-2018
(352) 589-8111
(352) 589-8495
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
—
NULL
208000000X
Pediatrics Physician
—
—
261QR1300X
Rural Health Clinic/Center
Primary
—
NULL
Other
Enumeration date
01/03/2007
Last updated
11/12/2025
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