Active NPI
Lacreasha Smith
- Phlebotomy Technician
- Live Oak, FL
National Provider Identifier
1679336994
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Phlebotomy Technician
- License
- 10098
- Practice address
- 118 Ohio Ave N Ste a
Live Oak, FL 32064-2464 - Phone
- (386) 365-9117
- NPI assigned
- Jan 31, 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Phlebotomy Technician | 246RP1900X | 10098 | FL | Primary |
Addresses
Primary practice location
118 Ohio Ave N Ste a
Live Oak, FL 32064-2464
Mailing address
1068 SE Putnam St
Lake City, FL 32025-5441
Phone (386) 365-9117
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 10098 | FL | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1706659200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1706659200000",
"number": "1679336994",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1068 SE PUTNAM ST",
"city": "LAKE CITY",
"state": "FL",
"postal_code": "320255441",
"telephone_number": "386-365-9117"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "118 OHIO AVE N STE A",
"city": "LIVE OAK",
"state": "FL",
"postal_code": "320642464",
"telephone_number": "386-365-9117"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SMITH",
"first_name": "LACREASHA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-01-31",
"last_updated": "2024-01-31",
"certification_date": "2023-11-14",
"status": "A"
},
"taxonomies": [
{
"code": "246RP1900X",
"taxonomy_group": "",
"desc": "Technician, Pathology, Phlebotomy",
"state": "FL",
"license": "10098",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Live Oak, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.