Individual
LAZINA JOHANNAH THOMAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
BA
Contact information
Practice address
315 CAROL ST, MASCOTTE, FL 34753-9253
(352) 429-2551
Mailing address
315 CAROL ST, MASCOTTE, FL 34753-9253
(352) 429-2551
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
692220196
—
FL
05
—
692220198
—
FL
Enumeration date
11/22/2010
Last updated
11/22/2010
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