Individual
LARA NICOLAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1600 SW ARCHER RD, GAINESVILLE, FL 32610-3001
(352) 265-0462
(352) 265-0443
Mailing address
PO BOX 100296, GAINESVILLE, FL 32610-0296
(352) 265-0462
(352) 265-0443
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
125.057377
IL
2080P0203X
Pediatric Critical Care Medicine Physician
Primary
ME127080
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
017856800
—
FL
Enumeration date
06/25/2010
Last updated
09/09/2016
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