Individual
JESMARIE CORREA-LASANTA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1350 HICKORY ST STE 101, MELBOURNE, FL 32901-3224
(321) 361-5670
(321) 676-6434
Mailing address
3300 S FISKE BLVD, ROCKLEDGE, FL 32955-4306
(321) 361-5630
(321) 676-6434
Taxonomy
Speciality
Code
Description
License number
State
207RI0200X
Infectious Disease Physician
Primary
ME131933
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
104224100
—
FL
01
—
NS400
MEDICARE HF
FL
Enumeration date
08/06/2014
Last updated
01/29/2024
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