Provider Demographics
NPI:1356794044
Name:LAWANDALES, JUSTIN RAY FRANK (APRN)
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:RAY FRANK
Last Name:LAWANDALES
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 MEDICAL PARK DR
Mailing Address - Street 2:SUITE 500
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33613-4680
Mailing Address - Country:US
Mailing Address - Phone:813-615-7028
Mailing Address - Fax:
Practice Address - Street 1:3000 MEDICAL PARK DR
Practice Address - Street 2:SUITE 500
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-4680
Practice Address - Country:US
Practice Address - Phone:813-615-7028
Practice Address - Fax:813-615-8008
Is Sole Proprietor?:No
Enumeration Date:2016-07-18
Last Update Date:2020-10-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLAPRN9316431363L00000X, 363LG0600X
FLARNP9316431363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner