Provider Demographics
NPI:1194392936
Name:LAKE CITY NURSING LLC
Entity Type:Organization
Organization Name:LAKE CITY NURSING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF ACCOUNTING
Authorized Official - Prefix:
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHARPLESS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-874-6007
Mailing Address - Street 1:3599 W LAKE MARY BLVD STE 1F
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-3417
Mailing Address - Country:US
Mailing Address - Phone:352-874-6007
Mailing Address - Fax:352-404-4078
Practice Address - Street 1:1270 SW MAIN BLVD
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32025-6684
Practice Address - Country:US
Practice Address - Phone:386-752-7900
Practice Address - Fax:386-758-6169
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-09
Last Update Date:2021-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL261629-00Medicaid