Provider Demographics
NPI:1992212740
Name:VARONA SANTANA, LAZARO BALDOMERO (ARNP)
Entity Type:Individual
Prefix:
First Name:LAZARO
Middle Name:BALDOMERO
Last Name:VARONA SANTANA
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1740 NW 88TH WAY
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33024-3319
Mailing Address - Country:US
Mailing Address - Phone:786-280-2055
Mailing Address - Fax:
Practice Address - Street 1:1740 NW 88TH WAY
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33024-3319
Practice Address - Country:US
Practice Address - Phone:786-280-2055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-02
Last Update Date:2023-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL17-686246ZC0007X
FLARPN11024769363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant