Provider Demographics
NPI:1871127381
Name:LANDAIS, LAETICIA (LPN)
Entity type:Individual
Prefix:
First Name:LAETICIA
Middle Name:
Last Name:LANDAIS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12001 AVALON LAKE DR APT 316
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32828-7378
Mailing Address - Country:US
Mailing Address - Phone:347-208-7717
Mailing Address - Fax:
Practice Address - Street 1:12001 AVALON LAKE DR APT 316
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32828-7378
Practice Address - Country:US
Practice Address - Phone:347-208-7717
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-24
Last Update Date:2020-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPN5223803164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse