Basic Information
| Provider Information | |||||||||
| NPI: | 1265920607 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LAO | ||||||||
| FirstName: | JAY | ||||||||
| MiddleName: | PETER | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10150 HIGHLAND MANOR DR STE 240 | ||||||||
| Address2: | |||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336109750 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8132591013 | ||||||||
| FaxNumber: | 8132540396 | ||||||||
| Practice Location | |||||||||
| Address1: | 10150 HIGHLAND MANOR DR STE 240 | ||||||||
| Address2: | |||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336109750 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8132591013 | ||||||||
| FaxNumber: | 8132540396 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/01/2018 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 03/29/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 722087 | CA | N | Nursing Service Providers | Registered Nurse | 363L00000X | APRN11014944 | FL | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 363L00000X | 811582 | NV | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 363L00000X | 95008875 | CA | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 363LG0600X | APRN11014944 | FL | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Gerontology | 363LA2200X | APRN11014944 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
No ID Information.