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General NPI Number Information
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NPI Number | 1699198903
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Entity Type | Organization
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Legal Business Name | LAKE MEDICAL CENTER PLLC
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Dates
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Enumeration Date | 01/23/2014
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Last Update Date | 04/13/2014
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Provider Practice Location Address
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Address Line | 425 SE 2ND ST
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City | BELLE GLADE
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State | FL
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Zip | 33430-3511
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Country | US
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Telephone | 561-992-0508
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Fax | 561-992-0510
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Provider Business Mailing Address
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Address Line | 425 SE 2ND ST
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City | BELLE GLADE
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State | FL
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Zip | 33430-3511
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Country | US
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Telephone | 561-992-0508
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Fax | 561-992-0510
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Authorized Official
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Title or Position | NURSE PRACTIONEER
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Name | SUSAN MCMILLAN
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Credential | ARNP
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Telephone | 561-992-0508
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | ARNP1951902
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License Number State | FL
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