Most Relevant Information
Provider Data
| NPI Number: | 1003640335 |
| Provider Name: | LAN POTTER NURSE PRACTITIONER |
| Entity Type: | Individual |
| Taxonomy Code: | 363LP2300X |
| Specialty: | Nurse Practitioner |
| License Number: | APRN11032275 |
Most Important Dates
| Enumeration Date: | 08/29/2024 |
| Last Updated: | 08/29/2024 |
Provider Practice Location
2640 57TH CIR E APT 202
ELLENTON
FL
34222
Practice Location Phone/Fax
| Phone: | 3196712270 |
| Fax: |
Provider Mailing Location
2640 57TH CIR E APT 202
2640 57TH CIR E APT 202
ELLENTON
FL
34222
Provider Mailing Phone/Fax
| Phone: | 3196712270 |
| Fax: |