Provider Demographics
NPI:1619210861
Name:MLACSON RNFA SERVICES INC.
Entity Type:Organization
Organization Name:MLACSON RNFA SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINSITRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MARILENE
Authorized Official - Middle Name:GOPEZ
Authorized Official - Last Name:LACSON
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:386-503-9731
Mailing Address - Street 1:PO BOX 350031
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32135-0031
Mailing Address - Country:US
Mailing Address - Phone:386-503-9731
Mailing Address - Fax:
Practice Address - Street 1:38 ROLLER LN
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32164-8939
Practice Address - Country:US
Practice Address - Phone:386-503-9731
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-05
Last Update Date:2015-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 9270072363LF0000X, 363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & GynecologyGroup - Single Specialty