Healthcare Provider Details

I. General information

NPI: 1982880944
Provider Name (Legal Business Name): LARA J FIX DO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/21/2008
Last Update Date: 01/06/2026
Certification Date: 01/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 SE OSCEOLA ST
STUART FL
34994-2431
US

IV. Provider business mailing address

PO BOX 1637
STUART FL
34995-1637
US

V. Phone/Fax

Practice location:
  • Phone: 772-219-9355
  • Fax: 772-219-9357
Mailing address:
  • Phone: 772-219-9355
  • Fax: 772-219-9357

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberOS9817
License Number StateFL

VIII. Authorized Official

Name: SHARON A RODNEY
Title or Position: CREDENTIALING
Credential:
Phone: 772-219-9355