Healthcare Provider Details

I. General information

NPI: 1376447938
Provider Name (Legal Business Name): LARA HOUGHTON APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2026
Last Update Date: 10/06/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4049 KAISER AVE
SAINT CLOUD FL
34772-9326
US

IV. Provider business mailing address

4049 KAISER AVE
SAINT CLOUD FL
34772-9326
US

V. Phone/Fax

Practice location:
  • Phone: 321-805-2424
  • Fax:
Mailing address:
  • Phone: 321-805-2424
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN110551351
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: