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General NPI Number Information
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NPI Number | 1619210861
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Entity Type | Organization
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Legal Business Name | MLACSON RNFA SERVICES INC.
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Dates
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Enumeration Date | 04/05/2013
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Last Update Date | 03/14/2015
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Provider Practice Location Address
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Address Line | 38 ROLLER LN
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City | PALM COAST
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State | FL
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Zip | 32164-8939
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Country | US
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Telephone | 386-503-9731
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 350031
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City | PALM COAST
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State | FL
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Zip | 32135-0031
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Country | US
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Telephone | 386-503-9731
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Fax |
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Authorized Official
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Title or Position | OWNER/ADMINSITRATOR
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Name | MS. MARILENE GOPEZ LACSON
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Credential | ARNP
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Telephone | 386-503-9731
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LX0001X
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Taxonomy Name | Obstetrics & Gynecology Nurse Practitioner
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License Number | ARNP 9270072
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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 | ARNP 9270072
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License Number State | FL
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