Healthcare Provider Details

I. General information

NPI: 1588542393
Provider Name (Legal Business Name): SETH GREGORY LAPE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2025
Last Update Date: 08/21/2025
Certification Date: 08/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10423 CENTURION PKWY N
JACKSONVILLE FL
32256-0527
US

IV. Provider business mailing address

96 BLIND OAK CIR
ST AUGUSTINE FL
32095-0151
US

V. Phone/Fax

Practice location:
  • Phone: 904-854-2090
  • Fax: 904-854-2093
Mailing address:
  • Phone: 601-754-5856
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156F00000X
TaxonomyTechnician/Technologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: