Healthcare Provider Details

I. General information

NPI: 1487421707
Provider Name (Legal Business Name): LANTERN HOMECARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2023
Last Update Date: 12/19/2023
Certification Date: 12/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7028 TIDEWATER TRL
TAMPA FL
33619-5953
US

IV. Provider business mailing address

7028 TIDEWATER TRL
TAMPA FL
33619-5953
US

V. Phone/Fax

Practice location:
  • Phone: 813-391-8174
  • Fax:
Mailing address:
  • Phone: 813-391-8174
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. TWANDA NICOLE MORRIS
Title or Position: MANAGER
Credential:
Phone: 813-391-8174