Provider Demographics
NPI:1164728945
Name:LAWRENCE, PENNY LANE (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:PENNY
Middle Name:LANE
Last Name:LAWRENCE
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 1:3401 CAPITAL MEDICAL BLVD
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-4425
Mailing Address - Country:US
Mailing Address - Phone:850-942-3937
Mailing Address - Fax:850-942-6279
Practice Address - Street 1:3401 CAPITAL MEDICAL BLVD
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-4425
Practice Address - Country:US
Practice Address - Phone:850-942-3937
Practice Address - Fax:850-942-6279
Is Sole Proprietor?:No
Enumeration Date:2011-01-27
Last Update Date:2011-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1787172363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner