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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

Other identifiers
Code
Description
Identifier
Issuer
State
05
305351200
FL
Enumeration date
05/03/2012
Last updated
05/03/2012
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