MEDICARE: MR. MARK LAZARICIU PA-C

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	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1578442752
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MARK LAZARICIU PA-C

Provider Business Mailing Address
First Line	:	960 58TH ST N
Second Line	:
City	:	SAINT PETERSBURG
State	:	FL
Zip	:	33710-6325
Country	:	US
Telephone Number	:	727-820-7778
Fax Number	:	727-820-7779

Provider Business Practice Location Address
First Line	:	960 58TH ST N
Second Line	:
City	:	SAINT PETERSBURG
State	:	FL
Zip	:	33710-6325
Country	:	US
Telephone Number	:	727-820-7778
Fax Number	:	727-820-7779

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

Provider Enumeration Date	:	09/01/2025
Last Update Date	:	01/05/2026

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