Individual
LACI LEE BOREM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
655 W 8TH ST, JACKSONVILLE, FL 32209-6511
(904) 749-1553
Mailing address
4317 ROCK PIGEON LN, MIDDLEBURG, FL 32068-8756
(904) 749-6063
Taxonomy
Speciality
Code
Description
License number
State
376K00000X
Nurse's Aide
Primary
424325
FL
Other
Enumeration date
06/26/2024
Last updated
06/26/2024
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