=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932736865
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CONNIE JANE LAGO MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/23/2020
-----------------------------------------------------
Last Update Date | 08/27/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1801 S OSPREY AVE UNIT 201
-----------------------------------------------------
City | SARASOTA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34239-3625
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 941-957-4767
-----------------------------------------------------
Fax | 941-955-7334
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4197 WOODLANDS PKWY
-----------------------------------------------------
City | PALM HARBOR
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34685-3493
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-333-1512
-----------------------------------------------------
Fax | 813-333-1561
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207N00000X
-----------------------------------------------------
Taxonomy Name | Dermatology Physician
-----------------------------------------------------
License Number | ME167839
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------