Provider Demographics
NPI:1083260111
Name:LAISIN, JANE
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:
Last Name:LAISIN
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 1:11411 DRIFTING LEAF DR
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33579-0002
Mailing Address - Country:US
Mailing Address - Phone:813-975-8329
Mailing Address - Fax:
Practice Address - Street 1:11411 DRIFTING LEAF DR
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33579-0002
Practice Address - Country:US
Practice Address - Phone:813-975-8329
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-14
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376J00000XNursing Service Related ProvidersHomemaker
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL100085143OtherFOSTER CARE