Provider Demographics
NPI:1669901278
Name:LAZARUS, DAPHNE PRIYA (LPN)
Entity type:Individual
Prefix:
First Name:DAPHNE
Middle Name:PRIYA
Last Name:LAZARUS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:DAPHNE
Other - Middle Name:PRIYA
Other - Last Name:LAZARUS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPN
Mailing Address - Street 1:800 W DR MARTIN LUTHER KING JR BLVD STE 4
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33603-3320
Mailing Address - Country:US
Mailing Address - Phone:813-910-8700
Mailing Address - Fax:813-371-9979
Practice Address - Street 1:800 W DR MARTIN LUTHER KING JR BLVD STE 4
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33603-3320
Practice Address - Country:US
Practice Address - Phone:813-910-8700
Practice Address - Fax:813-371-9979
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-07
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPN523034164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPN523034Medicaid
FL1669901278Medicaid