Provider Demographics
NPI:1083876312
Name:ASTARITA, LARAINE CATHERINE (COTA)
Entity Type:Individual
Prefix:MS
First Name:LARAINE
Middle Name:CATHERINE
Last Name:ASTARITA
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:423 HIGHWAY 466
Mailing Address - Street 2:APT 2105
Mailing Address - City:LADY LAKE
Mailing Address - State:FL
Mailing Address - Zip Code:32159-3798
Mailing Address - Country:US
Mailing Address - Phone:407-687-4174
Mailing Address - Fax:
Practice Address - Street 1:700 N PALMETTO ST
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748-4419
Practice Address - Country:US
Practice Address - Phone:352-323-5609
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-27
Last Update Date:2008-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OTA9889314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLOTA 9889OtherSTATE LICENSE