Provider Demographics
NPI:1083231591
Name:LABOSSIERE, ADLER (APRN)
Entity Type:Individual
Prefix:MR
First Name:ADLER
Middle Name:
Last Name:LABOSSIERE
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:N/A
Other - Middle Name:N/A
Other - Last Name:N/A
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APRN
Mailing Address - Street 1:24019 SORRENTO AVE
Mailing Address - Street 2:
Mailing Address - City:SORRENTO
Mailing Address - State:FL
Mailing Address - Zip Code:32776-8141
Mailing Address - Country:US
Mailing Address - Phone:352-406-8584
Mailing Address - Fax:352-729-2201
Practice Address - Street 1:24019 SORRENTO AVE
Practice Address - Street 2:
Practice Address - City:SORRENTO
Practice Address - State:FL
Practice Address - Zip Code:32776-8141
Practice Address - Country:US
Practice Address - Phone:352-406-8584
Practice Address - Fax:352-729-2201
Is Sole Proprietor?:No
Enumeration Date:2020-06-30
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11010389363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003599000Medicaid