Provider Demographics
NPI:1467982694
Name:MACKEY, LASHANTI ANESE (LPN)
Entity Type:Individual
Prefix:
First Name:LASHANTI
Middle Name:ANESE
Last Name:MACKEY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10211 41ST CT E
Mailing Address - Street 2:
Mailing Address - City:PARRISH
Mailing Address - State:FL
Mailing Address - Zip Code:34219-2035
Mailing Address - Country:US
Mailing Address - Phone:803-507-0317
Mailing Address - Fax:941-254-7993
Practice Address - Street 1:1200 54TH AVENUE DR W
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34207-3325
Practice Address - Country:US
Practice Address - Phone:941-254-7990
Practice Address - Fax:941-254-7993
Is Sole Proprietor?:No
Enumeration Date:2017-06-20
Last Update Date:2017-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL5211432164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse