Active NPI
Lashonda Coulbertson
- Family Nurse Practitioner
- Brandon, FL
National Provider Identifier
1316523996
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- APRN11026790
- Practice address
- 1335 Canyon Oaks Dr
Brandon, FL 33510-2175 - Phone
- (813) 468-7165
- NPI assigned
- Mar 23, 2021
- Reactivated
- Nov 29, 2023
- Last updated
- Jan 23, 2024
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | APRN11026790 | FL | Primary |
| Registered Nurse | 163W00000X | RN9487500 | FL |
Addresses
Primary practice location
1335 Canyon Oaks Dr
Brandon, FL 33510-2175
Mailing address
1335 Canyon Oaks Dr
Brandon, FL 33510-2175
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in FL
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Nurse Practitioner
- Education
- Other, 2023
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
12901 Bruce B Downs Blvd
Suite 62
Tampa, FL 33612-4799
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RN9487500 | FL | MD | Registered Nurse |
| APRN11026790 | FL | MD | Family Nurse Practitioner |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Physical Therapist
- Tampa, FL
- NPI 1992742324
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1616457600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1705968000000",
"number": "1316523996",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1335 CANYON OAKS DR",
"city": "BRANDON",
"state": "FL",
"postal_code": "335102175"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1335 CANYON OAKS DR",
"city": "BRANDON",
"state": "FL",
"postal_code": "335102175",
"telephone_number": "813-468-7165"
}
],
"practiceLocations": [],
"basic": {
"last_name": "COULBERTSON",
"first_name": "LASHONDA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-03-23",
"last_updated": "2024-01-23",
"certification_date": "2023-11-29",
"deactivation_date": "2022-02-01",
"reactivation_date": "2023-11-29",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "FL",
"license": "APRN11026790",
"primary": true
},
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "FL",
"license": "RN9487500",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Brandon, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.