Individual
LACIE BRISBON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
13166 ODYSSEY LAKE WAY, ORLANDO, FL 32826-4642
(407) 455-8258
Mailing address
13166 ODYSSEY LAKE WAY, ORLANDO, FL 32826-4642
(407) 455-8258
Taxonomy
Speciality
Code
Description
License number
State
133N00000X
Nutritionist
Primary
11585
FL
Other
Enumeration date
01/04/2021
Last updated
01/04/2021
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