Provider Demographics
NPI:1053060830
Name:SHANKAR, LARA (APRN, CPNP-PC)
Entity type:Individual
Prefix:
First Name:LARA
Middle Name:
Last Name:SHANKAR
Suffix:
Gender:F
Credentials:APRN, CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19228 NW US HIGHWAY 441
Mailing Address - Street 2:
Mailing Address - City:HIGH SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32643-8783
Mailing Address - Country:US
Mailing Address - Phone:352-792-5142
Mailing Address - Fax:
Practice Address - Street 1:19228 NW US HIGHWAY 441
Practice Address - Street 2:
Practice Address - City:HIGH SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32643-8783
Practice Address - Country:US
Practice Address - Phone:386-454-1156
Practice Address - Fax:360-462-5914
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-21
Last Update Date:2025-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11018641363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics