Provider Demographics
NPI:1154850683
Name:LANG, LARONDA LYNN (ARNP)
Entity Type:Individual
Prefix:
First Name:LARONDA
Middle Name:LYNN
Last Name:LANG
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15209 PLANTATION OAKS DR APT 2
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647-2177
Mailing Address - Country:US
Mailing Address - Phone:813-493-3063
Mailing Address - Fax:
Practice Address - Street 1:3165 N MCMULLEN BOOTH RD BLDG H
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33761-2034
Practice Address - Country:US
Practice Address - Phone:727-787-3911
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-08
Last Update Date:2017-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2960892363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily