Provider Demographics
NPI:1841597549
Name:ALBANO, LOU ANN MARIE (ARNP)
Entity Type:Individual
Prefix:
First Name:LOU ANN
Middle Name:MARIE
Last Name:ALBANO
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:LOU ANN
Other - Middle Name:
Other - Last Name:ALBANO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:135 E 1ST ST
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33805-4609
Mailing Address - Country:US
Mailing Address - Phone:863-686-2728
Mailing Address - Fax:863-686-6737
Practice Address - Street 1:5985 S FLORIDA AVE
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33813-2533
Practice Address - Country:US
Practice Address - Phone:863-644-8459
Practice Address - Fax:863-644-8450
Is Sole Proprietor?:No
Enumeration Date:2011-02-16
Last Update Date:2015-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPNP9191686364SF0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ER 9832Medicare PIN