Individual
KEVIN MAYORGA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
3916 CREWS LAKE DR, LAKELAND, FL 33813-3916
(863) 521-5638
Mailing address
3916 CREWS LAKE DR, LAKELAND, FL 33813-3916
Taxonomy
Speciality
Code
Description
License number
State
163WC0200X
Critical Care Medicine Registered Nurse
Primary
RN9511570
FL
Other
Enumeration date
09/29/2025
Last updated
09/29/2025
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