MEDICARE: DEAISA ZHANE BOMORT

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	172A00000X	Driver	B563179949530	FL

General Provider Information

NPI Number	:	1558035717
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEAISA ZHANE BOMORT

Provider Business Mailing Address
First Line	:	1836 N CRYSTAL LAKE DR
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33801-6576
Country	:	US
Telephone Number	:	863-738-9493
Fax Number	:

Provider Business Practice Location Address
First Line	:	1836 N CRYSTAL LAKE DR
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33801-6576
Country	:	US
Telephone Number	:	863-738-9493
Fax Number	:

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

Provider Enumeration Date	:	08/02/2021
Last Update Date	:	08/02/2021

Similar Medicare Providers

1538890082 — K&K LOVING HANDS LLC
Practice Location Address:

2015 TENNYSON ST
LAKELAND, FL
33801-6061

Practice Phone: 863-838-2735
Practice Fax:

1700667227 — K&K LOVING HANDS LLC
Practice Location Address:

2015 TENNYSON ST
LAKELAND, FL
33801-6061

Practice Phone: 863-838-2735
Practice Fax:

1447773502 — DR. BRADLEY W BARTEL JR. DC
Practice Location Address:

2125 CRYSTAL GROVE DR
LAKELAND, FL
33801-6875

Practice Phone: 863-701-2225
Practice Fax: 863-701-2221

1538667936 — JESUS MANUEL GARCIA FERNANDEZ
Practice Location Address:

206 N FLORIDA AVE
LAKELAND, FL
33801-4902

Practice Phone: 863-209-7003
Practice Fax: 863-274-3520

1023507860 — VIJAY VAGHASIYA MD
Practice Location Address:

206 N FLORIDA AVE
LAKELAND, FL
33801-4902

Practice Phone: 863-209-7003
Practice Fax: 863-274-3520

1285591685 — ESSENCE COUNSELING LLC
Practice Location Address:

238 N MASSACHUSETTS AVE STE G-19
LAKELAND, FL
33801-4987

Practice Phone: 863-670-4333
Practice Fax:

Directions to “ DEAISA ZHANE BOMORT ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.