Provider Demographics
NPI:1124239207
Name:LAZOVIC, NINA (MD)
Entity type:Individual
Prefix:MRS
First Name:NINA
Middle Name:
Last Name:LAZOVIC
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6131 LAGORCE DR
Mailing Address - Street 2:6131 LA GORCE DRIVE
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33140-2118
Mailing Address - Country:US
Mailing Address - Phone:305-772-7697
Mailing Address - Fax:
Practice Address - Street 1:6131 LAGORCE DR
Practice Address - Street 2:6131 LA GORCE DRIVE
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33140-2118
Practice Address - Country:US
Practice Address - Phone:305-772-7697
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2012-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME98974207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine