Provider Demographics
NPI:1154967271
Name:LOTIN, BEANCA (LPN)
Entity type:Individual
Prefix:
First Name:BEANCA
Middle Name:
Last Name:LOTIN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3077 TOWER OAKS DR
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32065-2546
Mailing Address - Country:US
Mailing Address - Phone:904-405-0892
Mailing Address - Fax:
Practice Address - Street 1:3077 TOWER OAKS DR
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32065-2546
Practice Address - Country:US
Practice Address - Phone:904-405-0892
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-24
Last Update Date:2019-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPN5242369164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse