Provider Demographics
NPI:1174825210
Name:THOMAS, LAZINA JOHANNAH (BA)
Entity Type:Individual
Prefix:
First Name:LAZINA
Middle Name:JOHANNAH
Last Name:THOMAS
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:LAZINA
Other - Middle Name:JOHANNAH
Other - Last Name:JOYNER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:315 CAROL ST
Mailing Address - Street 2:
Mailing Address - City:MASCOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:34753-9253
Mailing Address - Country:US
Mailing Address - Phone:352-429-2551
Mailing Address - Fax:
Practice Address - Street 1:315 CAROL ST
Practice Address - Street 2:
Practice Address - City:MASCOTTE
Practice Address - State:FL
Practice Address - Zip Code:34753-9253
Practice Address - Country:US
Practice Address - Phone:352-429-2551
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-22
Last Update Date:2010-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL692220196Medicaid
FL692220198Medicaid