Basic Information
Provider Information
NPI: 1083655070
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: LAWSON
FirstName: LEEANN
MiddleName:  
NamePrefix: MS.
NameSuffix:  
Credential: ARNP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: LAWSON
OtherFirstName: LEEANN
OtherMiddleName: PASSEROTTI
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType: 5
Mailing Information
Address1: PO BOX 918025
Address2:  
City: ORLANDO
State: FL
PostalCode: 328918025
CountryCode: US
TelephoneNumber: 3523926431
FaxNumber: 3523920547
Practice Location
Address1: 1600 SW ARCHER RD
Address2:  
City: GAINESVILLE
State: FL
PostalCode: 326103003
CountryCode: US
TelephoneNumber: 3523926431
FaxNumber: 3523920547
Other Information
ProviderEnumerationDate: 06/09/2006
LastUpdateDate: 03/07/2008
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LP0200XARNP3322212FLY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics

No ID Information.


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