Provider Demographics
NPI:1841924495
Name:LANE, CODY MARIE (AP)
Entity type:Individual
Prefix:
First Name:CODY
Middle Name:MARIE
Last Name:LANE
Suffix:
Gender:F
Credentials:AP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:463155 SR 200
Mailing Address - Street 2:SUITE #7
Mailing Address - City:YULEE
Mailing Address - State:FL
Mailing Address - Zip Code:32097
Mailing Address - Country:US
Mailing Address - Phone:715-252-7390
Mailing Address - Fax:
Practice Address - Street 1:463155 STATE ROAD 200 STE 7
Practice Address - Street 2:
Practice Address - City:YULEE
Practice Address - State:FL
Practice Address - Zip Code:32097-5506
Practice Address - Country:US
Practice Address - Phone:715-252-7390
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-11
Last Update Date:2025-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL4373171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist