Healthcare Provider Details

I. General information

NPI: 1730501495
Provider Name (Legal Business Name): LAMANUEL HIGHTOWER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/15/2014
Last Update Date: 11/16/2024
Certification Date: 11/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4648 SE SALVATORI RD
STUART FL
34997-8271
US

IV. Provider business mailing address

6270 LAKEPINE ST
SAINT CLOUD FL
34771-8940
US

V. Phone/Fax

Practice location:
  • Phone: 772-210-4362
  • Fax: 772-510-5780
Mailing address:
  • Phone: 615-692-9411
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberIMH25041
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: