Healthcare Provider Details

I. General information

NPI: 1053056838
Provider Name (Legal Business Name): LAQUISHA WASHINGTON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2022
Last Update Date: 05/04/2022
Certification Date: 05/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1317 EDGEWATER DR # 3096
ORLANDO FL
32804-6350
US

IV. Provider business mailing address

1317 EDGEWATER DR # 3096
ORLANDO FL
32804-6350
US

V. Phone/Fax

Practice location:
  • Phone: 321-599-3963
  • Fax:
Mailing address:
  • Phone: 321-599-3963
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: