Healthcare Provider Details

I. General information

NPI: 1639315732
Provider Name (Legal Business Name): VICKI DIANE LACHMAN PHD, APRN, MBE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/20/2008
Last Update Date: 06/18/2020
Certification Date: 06/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3810 GULF OF MEXICO DR # F107
LONGBOAT KEY FL
34228-2740
US

IV. Provider business mailing address

5380 GULF OF MEXICO DR STE 105
LONGBOAT KEY FL
34228-2048
US

V. Phone/Fax

Practice location:
  • Phone: 941-238-0266
  • Fax: 941-244-5505
Mailing address:
  • Phone: 941-238-0266
  • Fax: 941-244-5505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN11007219
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License NumberRN163230L
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License NumberAPRN11007219
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: