Individual
LAZENDRE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1933 HIBISCUS LN, RIVIERA BEACH, FL 33404-1872
(561) 537-0222
Mailing address
1933 HIBISCUS LN, RIVIERA BEACH, FL 33404-1872
(561) 537-0222
Taxonomy
Speciality
Code
Description
License number
State
376J00000X
Homemaker
Primary
—
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
112157300
—
FL
Enumeration date
11/07/2021
Last updated
11/07/2021
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