NPI 1558035717

Deaisa Zhane Bomort

Practitioner Driver Lakeland, FL

Practice location

Address: 1836 N Crystal Lake Dr, Lakeland, FL 33801-6576
Phone: (863) 738-9493

Registered specialties

Driver Primary

Other Service Providers Taxonomy 172A00000X Licence B563179949530 (FL)

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Registry record

NPI: 1558035717
Entity type: Individual
Sex (as registered): Female
NPI issued: 2 Aug 2021
Record last updated: 2 Aug 2021

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.