MEDICARE: LAKOSCIA HARRIS ARNP

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	363LP0200X	Pediatric Nurse Practitioner	ARNP9193529	FL

General Provider Information

NPI Number	:	1316327729
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAKOSCIA HARRIS ARNP

Provider Business Mailing Address
First Line	:	PO BOX 191
Second Line	:	PROVIDER ENROLLMENT DEPARTMENT
City	:	ROCKLAND
State	:	DE
Zip	:	19732-0191
Country	:	US
Telephone Number	:	302-651-6212
Fax Number	:	302-651-4945

Provider Business Practice Location Address
First Line	:	521 W STATE ROAD 434 STE 101
Second Line	:	PEDIATRIC&ADOLESCENT MED OF SEMINOLE, IN ASSOC WITH NEM
City	:	LONGWOOD
State	:	FL
Zip	:	32750-4952
Country	:	US
Telephone Number	:	407-830-5437
Fax Number	:	407-830-4907

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

Provider Enumeration Date	:	06/02/2015
Last Update Date	:	06/02/2015

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