Provider Demographics
NPI:1548987092
Name:LANE, PAULA
Entity type:Individual
Prefix:
First Name:PAULA
Middle Name:
Last Name:LANE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11448 EMMA OAKS LN
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32221-2863
Mailing Address - Country:US
Mailing Address - Phone:904-343-9253
Mailing Address - Fax:904-485-8110
Practice Address - Street 1:11448 EMMA OAKS LN
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32221-2863
Practice Address - Country:US
Practice Address - Phone:904-343-9253
Practice Address - Fax:904-485-8110
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-25
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health