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Organization
MAGNOLIA ADULT
Active
Organization
MAGNOLIA ADULT
Active
Organization subpart
No
Provider details
NPI number
Authorized official
IRA D LEE ARNP-C (PRESIDENT)
(386) 755-3300
Entity
Organization
Contact information
Practice address
1140 SW BASCOM NORRIS DR STE 105, LAKE CITY, FL 32025-1329
(386) 755-3300
(386) 755-8595
Mailing address
1140 SW BASCOM NORRIS DR STE 105, LAKE CITY, FL 32025-1329
(386) 755-3300
(386) 755-8595
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
ARNP3091702
FL
Other
Enumeration date
05/03/2012
Last updated
05/03/2012
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