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NPI Code Detail

MEDICARE: LILLIAN LASTRA ARNP

MEDICARE: LILLIAN LASTRA 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
1163W00000XRegistered NurseRN3224032FL
2363LF0000XFamily Nurse PractitionerAPRN3224032FL

Other Identifiers

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

General Provider Information

NPI Number : 1629584065
Entity Type Code : Individual
Provider Name (Legal Business Name) : LILLIAN LASTRA ARNP
Provider Business Mailing Address
First Line : 21097 NE 27TH CT STE 110
Second Line :
City : AVENTURA
State : FL
Zip : 33180-1206
Country : US
Telephone Number : 305-384-4720
Fax Number :
Provider Business Practice Location Address
First Line : 8967 TAFT ST
Second Line :
City : PEMBROKE PINES
State : FL
Zip : 33024-4648
Country : US
Telephone Number : 855-226-6633
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/21/2017
Last Update Date : 07/13/2020

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Directions to “ LILLIAN LASTRA ARNP” Practice Location

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