MEDICARE: ALEJANDRO LAZARO MOLINA APRN

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	363L00000X	Nurse Practitioner	9424378	FL
2	363LF0000X	Family Nurse Practitioner	APRN11000954	FL

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

General Provider Information

NPI Number	:	1275002883
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEJANDRO LAZARO MOLINA APRN

Provider Business Mailing Address
First Line	:	425 W COLONIAL DR STE 303
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32804-6863
Country	:	US
Telephone Number	:	321-332-6947
Fax Number	:	407-286-4515

Provider Business Practice Location Address
First Line	:	780 BUENAVENTURA BLVD
Second Line	:
City	:	KISSIMMEE
State	:	FL
Zip	:	34743-8128
Country	:	US
Telephone Number	:	407-274-9590
Fax Number	:	407-593-6102

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

Provider Enumeration Date	:	11/13/2018
Last Update Date	:	05/31/2024

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