Individual
MS. LOLITA CONDINO MASSENGILL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
6665 BANBURY ROAD, JACKSONVILLE, FL 32211
(904) 745-9333
(904) 743-0046
Mailing address
4850 MOTOR YACHT DR, JACKSONVILLE, FL 32225-4029
(904) 565-1641
(904) 996-0691
Taxonomy
Speciality
Code
Description
License number
State
363LG0600X
Gerontology Nurse Practitioner
Primary
ARNP2007072
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300697200
—
FL
Enumeration date
10/06/2005
Last updated
03/22/2012
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