MEDICARE: MS. BARBARA JEAN LANZ CRNA

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	367500000X	Certified Registered Nurse Anesthetist	033143	TN
2	101YM0800X	Mental Health Counselor	MH17537	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	3057409	OTHER	TN	BCBS NUMBER

General Provider Information

NPI Number	:	1982605861
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. BARBARA JEAN LANZ CRNA

Provider Business Mailing Address
First Line	:	1036 ONONDAGA TRAIL
Second Line	:
City	:	FORT MYERS BEACH
State	:	FL
Zip	:	33931
Country	:	US
Telephone Number	:	239-317-5533
Fax Number	:

Provider Business Practice Location Address
First Line	:	38 BARKLEY CIR
Second Line	:	SUITE 1
City	:	FORT MYERS
State	:	FL
Zip	:	33907-7526
Country	:	US
Telephone Number	:	239-317-5533
Fax Number	:

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

Provider Enumeration Date	:	08/02/2005
Last Update Date	:	02/09/2021

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