1245709740 NPI number — MRS. KATACEYA ANGELA LAMANNA APRN

Table of content: MRS. KATACEYA ANGELA LAMANNA APRN (NPI 1245709740)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245709740 NPI number — MRS. KATACEYA ANGELA LAMANNA APRN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LAMANNA
Provider First Name:
KATACEYA
Provider Middle Name:
ANGELA
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
APRN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
TAYLOR
Provider Other First Name:
KATACEYA
Provider Other Middle Name:
ANGELA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1245709740
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/14/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6900 TAVISTOCK LAKES BLVD STE 300
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ORLANDO
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32827-7592
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
863-646-4000
Provider Business Mailing Address Fax Number:
407-285-4515

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
550 POPE AVE NW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WINTER HAVEN
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33881-4679
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
863-299-2630
Provider Business Practice Location Address Fax Number:
407-285-4515
Provider Enumeration Date:
11/14/2018

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  APRN9378631 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 115136500 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com