Individual
PRINCESS J LOCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
2711 N ORANGE BLOSSOM TRL, KISSIMMEE, FL 34744-1373
(407) 380-0302
(407) 380-5127
Mailing address
3300 S FISKE BLVD, ROCKLEDGE, FL 32955-4306
(407) 222-4543
Taxonomy
Speciality
Code
Description
License number
State
363LW0102X
Women's Health Nurse Practitioner
Primary
APRN9237351
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
101437000
—
FL
01
—
OP567
MEDICARE HF
FL
Enumeration date
04/27/2018
Last updated
12/15/2021
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