MEDICARE: LAZINA JOHANNAH THOMAS BA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171M00000X	Case Manager/Care Coordinator

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1174825210
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAZINA JOHANNAH THOMAS BA

Provider Business Mailing Address
First Line	:	315 CAROL ST
Second Line	:
City	:	MASCOTTE
State	:	FL
Zip	:	34753-9253
Country	:	US
Telephone Number	:	352-429-2551
Fax Number	:

Provider Business Practice Location Address
First Line	:	315 CAROL ST
Second Line	:
City	:	MASCOTTE
State	:	FL
Zip	:	34753-9253
Country	:	US
Telephone Number	:	352-429-2551
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/22/2010
Last Update Date	:	11/22/2010

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