Individual
MRS. JENNIFER L LAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4298 GREAT EGRET WAY, MIDDLEBURG, FL 32068-8760
(803) 318-2052
Mailing address
3342 NOKOMIS RD, ORANGE PARK, FL 32073-6620
(904) 608-7784
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
06/07/2020
Last updated
06/07/2020
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