Provider Demographics
NPI:1649721390
Name:LAWRENCE, KRIZIA
Entity type:Individual
Prefix:MS
First Name:KRIZIA
Middle Name:
Last Name:LAWRENCE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3691 STATE ROAD 580 W STE C
Mailing Address - Street 2:
Mailing Address - City:OLDSMAR
Mailing Address - State:FL
Mailing Address - Zip Code:34677-5635
Mailing Address - Country:US
Mailing Address - Phone:727-278-2220
Mailing Address - Fax:
Practice Address - Street 1:3691 STATE ROAD 580 W STE C
Practice Address - Street 2:
Practice Address - City:OLDSMAR
Practice Address - State:FL
Practice Address - Zip Code:34677-5635
Practice Address - Country:US
Practice Address - Phone:727-278-2220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-18
Last Update Date:2016-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No372600000XNursing Service Related ProvidersAdult Companion
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL018352800Medicaid