Provider Demographics
NPI:1245476894
Name:SIEGEL, LAWRENCE D (ARNP)
Entity type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:D
Last Name:SIEGEL
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2405 SE 17TH ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-9192
Mailing Address - Country:US
Mailing Address - Phone:352-690-2171
Mailing Address - Fax:352-690-6954
Practice Address - Street 1:2500 W LAKE MARY BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-3501
Practice Address - Country:US
Practice Address - Phone:407-936-0976
Practice Address - Fax:407-936-0977
Is Sole Proprietor?:No
Enumeration Date:2009-01-05
Last Update Date:2010-03-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLARNP9178835363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLBT020ZMedicare PIN