Provider Demographics
NPI:1831504471
Name:FRAZIER, LULA M
Entity type:Individual
Prefix:
First Name:LULA
Middle Name:M
Last Name:FRAZIER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LULA
Other - Middle Name:M
Other - Last Name:FRAZIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2513 DORA AVE
Mailing Address - Street 2:
Mailing Address - City:TAVARES
Mailing Address - State:FL
Mailing Address - Zip Code:32778-4977
Mailing Address - Country:US
Mailing Address - Phone:352-508-9552
Mailing Address - Fax:352-508-9798
Practice Address - Street 1:2513 DORA AVE
Practice Address - Street 2:
Practice Address - City:TAVARES
Practice Address - State:FL
Practice Address - Zip Code:32778-4977
Practice Address - Country:US
Practice Address - Phone:352-508-9552
Practice Address - Fax:352-508-9798
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-23
Last Update Date:2020-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL233478251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health