Healthcare Provider Details

I. General information

NPI: 1174461677
Provider Name (Legal Business Name): JAHAIRA TLASECA-LORA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2026
Last Update Date: 03/24/2026
Certification Date: 03/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

729 WATERBRIDGE DR
WINTER HAVEN FL
33880-1726
US

IV. Provider business mailing address

729 WATERBRIDGE DR
WINTER HAVEN FL
33880-1726
US

V. Phone/Fax

Practice location:
  • Phone: 941-447-9344
  • Fax:
Mailing address:
  • Phone: 941-447-9344
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11046198
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: