Provider Demographics
NPI:1023322245
Name:HALL, LACHANTHIA NICOLE (CNA,, HHA MEDIC)
Entity type:Individual
Prefix:MRS
First Name:LACHANTHIA
Middle Name:NICOLE
Last Name:HALL
Suffix:
Gender:F
Credentials:CNA,, HHA MEDIC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 N MONROE ST STE 11-228
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32303-5535
Mailing Address - Country:US
Mailing Address - Phone:850-212-9663
Mailing Address - Fax:
Practice Address - Street 1:1700 N MONROE ST STE 11-228 TALLAHASSEE
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE FLORIDA 32303
Practice Address - State:FL
Practice Address - Zip Code:32304-5019
Practice Address - Country:US
Practice Address - Phone:850-212-9663
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-29
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL238524251E00000X
FL692947898222Q00000X
FL6929478962255R0406X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
No2255R0406XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistRehabilitation, Blind
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL106736600Medicaid
FL23854Medicaid