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General NPI Number Information
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NPI Number | 1265920607
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Entity Type | Individual
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Provider Name | JAY PETER LAO NP
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Gender | Male
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Dates
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Enumeration Date | 05/01/2018
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Last Update Date | 01/25/2023
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Provider Practice Location Address
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Address Line | 1505 53RD AVE E
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City | BRADENTON
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State | FL
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Zip | 34203-4249
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Country | US
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Telephone | 941-357-7950
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Fax | 941-840-1003
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Provider Business Mailing Address
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Address Line | 1505 53RD AVE E
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City | BRADENTON
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State | FL
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Zip | 34203-4249
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Country | US
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Telephone | 941-357-7950
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Fax | 941-840-1003
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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 | APRN11014944
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 811582
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License Number State | NV
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Taxonomy #3
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 95008875
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | APRN11014944
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License Number State | FL
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Taxonomy #5
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | APRN11014944
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License Number State | FL
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Taxonomy #6
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 722087
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License Number State | CA
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