Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | ARNP9211669 | FL |
NPI | 1023301942 |
---|---|
Provider Name | Anthony Lagana |
First Address | New Smyrna Beach, FL 32169-5303 |
Second Address | New Smyrna Beach, FL 32169-5303 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/05/2011 |
Last Update Date | 25/05/2011 |