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
—
—
261QR1300X
Rural Health Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
126977000
—
FL
Enumeration date
01/03/2007
Last updated
11/12/2025
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