Individual
LACRESA LARAE CITIZEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
1171 LANE AVE S APT 1504, JACKSONVILLE, FL 32205-6293
(904) 924-4129
Mailing address
1171 LANE AVE S APT 1504, JACKSONVILLE, FL 32205-6293
(904) 924-4129
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
9321193
FL
Other
Enumeration date
09/14/2011
Last updated
09/14/2011
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