Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RN0300X | Nephrologist | OS 12060 | FL |
NPI | 1063640126 |
---|---|
Provider Name | Mrs. Janis S Lawrence-Jackson |
First Address | Sarasota, FL 34239-2943 |
Second Address | Sarasota, FL 34239-2943 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2009 |
Last Update Date | 07/11/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
HN486Z | MEDICARE PTAN (01) | FL |