Provider Demographics
NPI:1205151677
Name:RAYSIDE, LAMISA SMITH (ARNP)
Entity type:Individual
Prefix:MRS
First Name:LAMISA
Middle Name:SMITH
Last Name:RAYSIDE
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:100 W GORE ST
Mailing Address - Street 2:SUITE # 500
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-1044
Mailing Address - Country:US
Mailing Address - Phone:407-649-8707
Mailing Address - Fax:407-447-0222
Practice Address - Street 1:100 W GORE ST
Practice Address - Street 2:SUITE # 500
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-1044
Practice Address - Country:US
Practice Address - Phone:407-649-8707
Practice Address - Fax:407-447-0222
Is Sole Proprietor?:No
Enumeration Date:2010-03-29
Last Update Date:2014-07-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLARNP9176730363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care