Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LG0600X | Nurse Practitioner - Gerontology | 11008827 | FL |
NPI | 1053924589 |
---|---|
Provider Name | Margaline Lazarre |
First Address | Clermont, FL 34711-5905 |
Second Address | Clermont, FL 34711-5905 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/08/2020 |
Last Update Date | 25/08/2020 |