Provider Demographics
NPI:1235909664
Name:LASTRA, JOSCELYNE (APRN)
Entity Type:Individual
Prefix:
First Name:JOSCELYNE
Middle Name:
Last Name:LASTRA
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3506 E 23RD ST
Mailing Address - Street 2:
Mailing Address - City:ALVA
Mailing Address - State:FL
Mailing Address - Zip Code:33920-1312
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3506 E 23RD ST
Practice Address - Street 2:
Practice Address - City:ALVA
Practice Address - State:FL
Practice Address - Zip Code:33920-1312
Practice Address - Country:US
Practice Address - Phone:305-216-3228
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-05
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11030315363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily