Basic Information
| Provider Information | |||||||||
| NPI: | 1811269616 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LANZOLA | ||||||||
| FirstName: | MEGHAN | ||||||||
| MiddleName: | ANNE | ||||||||
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| Credential: | APRN | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | SCHULTZ | ||||||||
| OtherFirstName: | MEGHAN | ||||||||
| OtherMiddleName: | ANNE | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1005 MAR WALT DRIVE | ||||||||
| Address2: | ADMINISTRATION | ||||||||
| City: | FORT WALTON BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 325476707 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8508638150 | ||||||||
| FaxNumber: | 8508634152 | ||||||||
| Practice Location | |||||||||
| Address1: | 2001 E. HIGHWAY 20 | ||||||||
| Address2: | FAMILY MEDICINE DEPARTMENT | ||||||||
| City: | NICEVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 325788826 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8508974400 | ||||||||
| FaxNumber: | 8508970623 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/08/2012 | ||||||||
| LastUpdateDate: | 08/29/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | APRN11003856 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.