Provider Demographics
NPI:1104462423
Name:LANE, GEOFFREY C (RRT-ACCS)
Entity type:Individual
Prefix:
First Name:GEOFFREY
Middle Name:C
Last Name:LANE
Suffix:
Gender:M
Credentials:RRT-ACCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4216 OLD MILL COVE TRL W
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32277-1582
Mailing Address - Country:US
Mailing Address - Phone:813-817-3863
Mailing Address - Fax:904-256-4646
Practice Address - Street 1:4216 OLD MILL COVE TRL W
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32277-1582
Practice Address - Country:US
Practice Address - Phone:813-817-3863
Practice Address - Fax:904-256-4646
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-21
Last Update Date:2019-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant