Provider Demographics
NPI:1205207883
Name:LAVAUD, NASSER
Entity Type:Individual
Prefix:
First Name:NASSER
Middle Name:
Last Name:LAVAUD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2601 10TH AVE N
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PALM SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33461-3141
Mailing Address - Country:US
Mailing Address - Phone:561-642-1008
Mailing Address - Fax:561-802-3976
Practice Address - Street 1:1250 SOUTHWINDS DR
Practice Address - Street 2:
Practice Address - City:LANTANA
Practice Address - State:FL
Practice Address - Zip Code:33462-1459
Practice Address - Country:US
Practice Address - Phone:561-582-5559
Practice Address - Fax:561-439-4384
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-08
Last Update Date:2021-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9299825363LF0000X
FLARNP9299825363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily