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General NPI Number Information
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NPI Number | 1740894690
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Entity Type | Individual
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Provider Name | MARIA LEZCANO TOMMOLINO APRN
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Gender | Female
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Dates
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Enumeration Date | 09/08/2020
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Last Update Date | 01/04/2022
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Provider Practice Location Address
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Address Line | 11479 CORTEZ BLVD
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City | BROOKSVILLE
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State | FL
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Zip | 34613-7367
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Country | US
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Telephone | 352-597-3511
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Fax | 352-597-1155
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Provider Business Mailing Address
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Address Line | 14690 SPRING HILL DR STE 305
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City | SPRING HILL
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State | FL
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Zip | 34609-8102
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Country | US
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Telephone | 352-277-5348
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Fax | 352-606-2857
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | F06192611
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License Number State | GA
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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 | APRN11014129
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License Number State | FL
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