Provider Demographics
NPI:1548796998
Name:MCCLAIN, LAQUISTA (LPN)
Entity Type:Individual
Prefix:
First Name:LAQUISTA
Middle Name:
Last Name:MCCLAIN
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 1:4178 LORENZO CT APT 2
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32208-2991
Mailing Address - Country:US
Mailing Address - Phone:904-803-7464
Mailing Address - Fax:
Practice Address - Street 1:4178 LORENZO CT APT 2
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32208-2991
Practice Address - Country:US
Practice Address - Phone:904-803-7464
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-04
Last Update Date:2017-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPN 1306191164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse