MEDICARE: LARA L CORTES 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	363LA2200X	Adult Health Nurse Practitioner	APRN11000276	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4H07X	OTHER	FL	FLORIDA BLUE

General Provider Information

NPI Number	:	1790254639
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LARA L CORTES APRN

Provider Business Mailing Address
First Line	:	520 E TARPON AVE
Second Line	:
City	:	TARPON SPRINGS
State	:	FL
Zip	:	34689-4324
Country	:	US
Telephone Number	:	727-935-1185
Fax Number	:	727-935-1183

Provider Business Practice Location Address
First Line	:	520 E TARPON AVE
Second Line	:
City	:	TARPON SPRINGS
State	:	FL
Zip	:	34689-4324
Country	:	US
Telephone Number	:	727-935-1185
Fax Number	:	727-935-1183

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

Provider Enumeration Date	:	11/21/2018
Last Update Date	:	04/15/2025

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