Provider Demographics
NPI:1750773321
Name:CARE CENTER OF LAKE PLACID
Entity type:Organization
Organization Name:CARE CENTER OF LAKE PLACID
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:VERONICA
Authorized Official - Middle Name:GERTRUDE
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:754-260-7467
Mailing Address - Street 1:299 E INTERLAKE BLVD
Mailing Address - Street 2:
Mailing Address - City:LAKE PLACID
Mailing Address - State:FL
Mailing Address - Zip Code:33852-9621
Mailing Address - Country:US
Mailing Address - Phone:754-260-7467
Mailing Address - Fax:863-465-2525
Practice Address - Street 1:299 E INTERLAKE BLVD
Practice Address - Street 2:
Practice Address - City:LAKE PLACID
Practice Address - State:FL
Practice Address - Zip Code:33852-9621
Practice Address - Country:US
Practice Address - Phone:754-260-7467
Practice Address - Fax:863-465-2525
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-19
Last Update Date:2024-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty