Provider Demographics
NPI:1053924589
Name:LAZARRE, MARGALINE (APRN)
Entity type:Individual
Prefix:
First Name:MARGALINE
Middle Name:
Last Name:LAZARRE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17343 SUMMER OAK LN
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-5905
Mailing Address - Country:US
Mailing Address - Phone:863-409-1330
Mailing Address - Fax:
Practice Address - Street 1:17343 SUMMER OAK LN
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-5905
Practice Address - Country:US
Practice Address - Phone:863-409-1330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-25
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11008827363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology