Provider Demographics
NPI:1760503429
Name:CANNER, LAISHA BLISS (AP)
Entity Type:Individual
Prefix:
First Name:LAISHA
Middle Name:BLISS
Last Name:CANNER
Suffix:
Gender:F
Credentials:AP
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:737 NW 24TH AVE
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32609-2958
Mailing Address - Country:US
Mailing Address - Phone:352-271-1211
Mailing Address - Fax:352-379-4884
Practice Address - Street 1:901 NW 8TH AVE STE A1
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32601-5000
Practice Address - Country:US
Practice Address - Phone:352-271-1211
Practice Address - Fax:352-379-4884
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLAP1383171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLC0778OtherBLUE CROSS BLUE SHIELD