Provider Demographics
NPI:1316523996
Name:COULBERTSON, LASHONDA
Entity type:Individual
Prefix:
First Name:LASHONDA
Middle Name:
Last Name:COULBERTSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1335 CANYON OAKS DR
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33510-2175
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1335 CANYON OAKS DR
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33510-2175
Practice Address - Country:US
Practice Address - Phone:813-468-7165
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-23
Last Update Date:2024-01-23
Deactivation Date:2022-02-01
Deactivation Code:
Reactivation Date:2023-11-29
Provider Licenses
StateLicense IDTaxonomies
FLRN9487500163W00000X
FLAPRN11026790363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse