Provider Demographics
NPI:1063640126
Name:LAWRENCE-JACKSON, JANIS S (DO)
Entity Type:Individual
Prefix:MRS
First Name:JANIS
Middle Name:S
Last Name:LAWRENCE-JACKSON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1921 WALDEMERE ST
Mailing Address - Street 2:SUITE 306
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239-2943
Mailing Address - Country:US
Mailing Address - Phone:941-917-8722
Mailing Address - Fax:941-917-8727
Practice Address - Street 1:1921 WALDEMERE ST
Practice Address - Street 2:SUITE 306
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-2943
Practice Address - Country:US
Practice Address - Phone:941-917-8722
Practice Address - Fax:941-917-8727
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-29
Last Update Date:2013-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS 12060207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLHN486ZOtherMEDICARE PTAN