Healthcare Provider Details

I. General information

NPI: 1972070183
Provider Name (Legal Business Name): ROLANDE ANTOINE LAZARRE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/25/2018
Last Update Date: 10/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5099 NW FIDDLE LEAF CT
PORT SAINT LUCIE FL
34986-4380
US

IV. Provider business mailing address

5099 NW FIDDLE LEAF CT
PORT SAINT LUCIE FL
34986-4380
US

V. Phone/Fax

Practice location:
  • Phone: 772-940-1697
  • Fax: 772-237-4155
Mailing address:
  • Phone: 772-940-1697
  • Fax: 772-237-4155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: