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Organization

LAKE PULMONARY CRITICAL CARE P A

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MS. JESSICA LYNN BARBER (OPERATIONS MANAGER)
(352) 742-4631
Entity
Organization

Contact information

Practice address
1876 NIGHTINGALE LN, TAVARES, FL 32778-4359
(352) 742-4447
(352) 742-4448
Mailing address
1876 NIGHTINGALE LN, TAVARES, FL 32778-4359
(352) 742-4447
(352) 742-4448

Taxonomy

Speciality
Code
Description
License number
State
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
207RP1001X
Pulmonary Disease Physician
Primary
207RS0012X
Sleep Medicine (Internal Medicine) Physician
363LA2200X
Adult Health Nurse Practitioner
ARNP9218919
FL
364SC0200X
Critical Care Medicine Clinical Nurse Specialist
ARNP9218919
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
21518
BCBS PROVIDER NUMBER
FL
05
254399100
FL
01
2900100538
MEDICARE RAILROAD
FL
Enumeration date
11/10/2005
Last updated
01/13/2011
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