Organization
MAGNOLIA ADULT
Active
Organization
MAGNOLIA ADULT
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. IRA D LEE ARNP (OWNER)
(386) 755-3300
Entity
Organization
Contact information
Practice address
1211 SW BASCOM NORRIS DR STE 201, LAKE CITY, FL 32025-4916
(375) 755-3300
(386) 755-8595
Mailing address
1211 SW BASCOM NORRIS DR STE 201, LAKE CITY, FL 32025-4916
(375) 755-3300
(386) 755-8595
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
ARNP3091702
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
Y02HU
BLUE CROSS BLUE SHIELD
FL
Enumeration date
12/30/2013
Last updated
12/30/2013
Update your record
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