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General NPI Number Information
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NPI Number | 1730987926
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Entity Type | Individual
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Provider Name | LAKESHIA COUSIN APRN, AGPCNP-BC
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Gender | Female
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Dates
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Enumeration Date | 03/04/2025
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Last Update Date | 03/04/2025
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Provider Practice Location Address
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Address Line | 16939 SW 134TH AVE
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City | ARCHER
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State | FL
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Zip | 32618-5413
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Country | US
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Telephone | 352-265-2550
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Fax |
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Provider Business Mailing Address
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Address Line | 10518 CARDERA DR
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City | RIVERVIEW
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State | FL
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Zip | 33578-4702
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Country | US
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Telephone | 727-417-5406
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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 | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | APRN9369132
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License Number State | FL
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