Tracey Lasane
Individual provider Active NPI Driver · Lake Park, GA
NPI 1134824998 · NPPES record last updated Apr 3, 2023
Key facts
- NPI
- 1134824998
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Driver 172A00000X
- License
- 053089940 (GA)
- Practice address
- 5114 Diamond Dr
Lake Park, GA 31636-3087 - Phone
- (850) 739-1233
- NPI assigned
- Apr 3, 2023
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 053089940 | GA | MD | Driver |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Driver | 172A00000X | 053089940 | GA | Yes |
Addresses
Primary practice location
5114 Diamond Dr
Lake Park, GA 31636-3087
Mailing address
5114 Diamond Dr
Lake Park, GA 31636-3087
Phone (850) 739-1233
Other providers in Lake Park, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 3, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.