MEDICARE: DR. NICOLE LAMAS MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program	390200000X	PR
2	390200000X	Student in an Organized Health Care Education/Training Program		CT
3	207Q00000X	Family Medicine Physician	ME164278	FL

General Provider Information

NPI Number	:	1376021907
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NICOLE LAMAS MD

Provider Business Mailing Address
First Line	:	71 HAYNES ST
Second Line	:
City	:	MANCHESTER
State	:	CT
Zip	:	06040-4188
Country	:	US
Telephone Number	:	860-533-4679
Fax Number	:

Provider Business Practice Location Address
First Line	:	5469 SW 34TH ST
Second Line	:
City	:	GAINESVILLE
State	:	FL
Zip	:	32608-5032
Country	:	US
Telephone Number	:	352-548-1900
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/06/2018
Last Update Date	:	09/06/2023

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