Provider Demographics
NPI:1639892904
Name:MAQUEIRA, LAZARA DAILES (FNP)
Entity Type:Individual
Prefix:
First Name:LAZARA
Middle Name:DAILES
Last Name:MAQUEIRA
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7609 SHARON DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33617-8105
Mailing Address - Country:US
Mailing Address - Phone:813-325-8038
Mailing Address - Fax:
Practice Address - Street 1:7609 SHARON DR
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33617-8105
Practice Address - Country:US
Practice Address - Phone:813-325-8038
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-22
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11018130363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily