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General NPI Number Information
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NPI Number | 1528877123
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Entity Type | Individual
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Provider Name | LYDIA MARIE LASER DNP, APRN, CRNA
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Gender | Female
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Dates
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Enumeration Date | 01/07/2025
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Last Update Date | 01/28/2025
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Provider Practice Location Address
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Address Line | 3625 UNIVERSITY BLVD S
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City | JACKSONVILLE
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State | FL
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Zip | 32216-4207
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Country | US
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Telephone | 904-702-6111
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Fax |
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Provider Business Mailing Address
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Address Line | 4713 FRENCH ST
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City | JACKSONVILLE
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State | FL
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Zip | 32205-5001
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Country | US
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Telephone | 860-227-2004
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Fax |
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN9443824
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 11037321
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License Number State | FL
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