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General NPI Number Information
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NPI Number | 1104719137
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Entity Type | Individual
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Provider Name | ANDREW JESUS LAZO
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Gender | Male
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Dates
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Enumeration Date | 05/29/2025
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Last Update Date | 08/06/2025
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Provider Practice Location Address
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Address Line | 1400 N SEMORAN BLVD BLDG SUITEE
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City | ORLANDO
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State | FL
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Zip | 32807-3536
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Country | US
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Telephone | 407-823-8421
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Fax | 407-823-8195
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Provider Business Mailing Address
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Address Line | 1400 N SEMORAN BLVD BLDG SUITEE
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City | ORLANDO
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State | FL
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Zip | 32807-3536
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Country | US
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Telephone | 407-823-8421
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Fax | 407-823-8195
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 11039812
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | APRN11039812
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 11039812
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License Number State | FL
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Taxonomy #4
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 11039812
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License Number State | FL
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