Provider Demographics
NPI:1578227005
Name:LA O LAMADRID, LITZ
Entity Type:Individual
Prefix:
First Name:LITZ
Middle Name:
Last Name:LA O LAMADRID
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18720 LAKE COMMISTON DR
Mailing Address - Street 2:
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33549-3823
Mailing Address - Country:US
Mailing Address - Phone:813-965-3286
Mailing Address - Fax:
Practice Address - Street 1:18720 LAKE COMMISTON DR
Practice Address - Street 2:
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33549-3823
Practice Address - Country:US
Practice Address - Phone:813-965-3286
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-31
Last Update Date:2021-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11015816363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAPRN11015816OtherAPRN