Provider Demographics
NPI:1043893035
Name:LAZARUS, JACQUELINE ARLENE
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:ARLENE
Last Name:LAZARUS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8060 NW 96TH TER APT 306
Mailing Address - Street 2:
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33321-1360
Mailing Address - Country:US
Mailing Address - Phone:754-264-5807
Mailing Address - Fax:
Practice Address - Street 1:8060 NW 96TH TER APT 306
Practice Address - Street 2:
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33321-1360
Practice Address - Country:US
Practice Address - Phone:754-264-5807
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-28
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9283554163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLRN9283554OtherFLORIDA DEPARTMENT OF HEALTH
FLRN9283554OtherREGISTERED NURSE