Provider Demographics
NPI:1881995579
Name:LANTZ, DEANA M (ARNP-C)
Entity type:Individual
Prefix:MS
First Name:DEANA
Middle Name:M
Last Name:LANTZ
Suffix:
Gender:F
Credentials:ARNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4211 VAN DYKE RD STE 101B
Mailing Address - Street 2:
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33558-8005
Mailing Address - Country:US
Mailing Address - Phone:813-960-4026
Mailing Address - Fax:813-443-8166
Practice Address - Street 1:4211 VAN DYKE RD
Practice Address - Street 2:SUIT 101B
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33558-8005
Practice Address - Country:US
Practice Address - Phone:813-960-4026
Practice Address - Fax:813-443-8166
Is Sole Proprietor?:No
Enumeration Date:2010-11-11
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP011064363LF0000X
FLARNP9429783363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL017980000Medicaid
FL017980000Medicaid