# LAKE PEDIATRICS P. A.

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Lake Pediatrics, P.A.
- **Organization subpart:** No

## Provider details

- **NPI number:** 1942367370
- **Authorized official:** DONNA LYNN NETTLES (BILLING MANAGER)
- **Authorized official phone:** (523) 638-4997

## Contact information

- **Practice address:** 4880 N HIGHWAY 19A STE 200, MOUNT DORA, FL 32757-2018
- **Practice address phone:** (352) 589-8111
- **Practice address fax:** (352) 589-8111
- **Mailing address:** 4880 N HWY 19 A, MT DORA, FL 32757-2018
- **Mailing address phone:** (352) 589-8111
- **Mailing address fax:** (352) 589-8495

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208000000X | Pediatrics Physician | — | NULL | — |
| 208000000X | Pediatrics Physician | — | — | — |
| 261QR1300X | Rural Health Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 01/03/2007
- **Last updated:** 11/12/2025