Healthcare Provider Details

I. General information

NPI: 1255053575
Provider Name (Legal Business Name): LANIE ESPEJO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2022
Last Update Date: 09/13/2022
Certification Date: 09/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28639 TRANQUIL LAKE CIR
WESLEY CHAPEL FL
33543-6593
US

IV. Provider business mailing address

28639 TRANQUIL LAKE CIR
WESLEY CHAPEL FL
33543-6593
US

V. Phone/Fax

Practice location:
  • Phone: 408-704-0028
  • Fax:
Mailing address:
  • Phone: 408-704-0028
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11021845
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: