Individual
JANE LAISIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
11411 DRIFTING LEAF DR, RIVERVIEW, FL 33579-0002
(813) 975-8329
Mailing address
11411 DRIFTING LEAF DR, RIVERVIEW, FL 33579-0002
(813) 975-8329
Taxonomy
Speciality
Code
Description
License number
State
3747P1801X
Personal Care Attendant
—
—
376J00000X
Homemaker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
100085143
FOSTER CARE
FL
Enumeration date
08/14/2019
Last updated
05/03/2022
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