Healthcare Provider Details

I. General information

NPI: 1114842002
Provider Name (Legal Business Name): LAKELAND REGIONAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 PABLO ST
LAKELAND FL
33803-3818
US

IV. Provider business mailing address

130 PABLO ST
LAKELAND FL
33803-3818
US

V. Phone/Fax

Practice location:
  • Phone: 863-284-5000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SHELBY HUNTER
Title or Position: PATIENT ACCESS REPRESENTATIVE
Credential:
Phone: 863-284-5000