Provider Demographics
NPI:1639923915
Name:KIRBY, LASCELLES (RN)
Entity Type:Individual
Prefix:MR
First Name:LASCELLES
Middle Name:
Last Name:KIRBY
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14261 SW 120TH ST STE 108-531
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-7270
Mailing Address - Country:US
Mailing Address - Phone:954-248-0096
Mailing Address - Fax:954-686-5574
Practice Address - Street 1:7901 4TH ST N STE 300
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33702-4399
Practice Address - Country:US
Practice Address - Phone:954-248-0096
Practice Address - Fax:954-686-5574
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-15
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9213651163WC3500X, 163WD1100X, 171M00000X, 163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management
No163WC3500XNursing Service ProvidersRegistered NurseCardiac Rehabilitation
No163WD1100XNursing Service ProvidersRegistered NurseDialysis, Peritoneal
No171M00000XOther Service ProvidersCase Manager/Care Coordinator