Provider Demographics
NPI:1053044370
Name:LANCE, DAVID KYLE
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:KYLE
Last Name:LANCE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2836 CHEROKEE CIR S
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32205-5800
Mailing Address - Country:US
Mailing Address - Phone:904-403-0120
Mailing Address - Fax:
Practice Address - Street 1:2836 CHEROKEE CIR S
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32205-5800
Practice Address - Country:US
Practice Address - Phone:904-403-0120
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-05
Last Update Date:2022-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services