Provider Demographics
NPI:1396457511
Name:LAMAR, SUHVANNA VICTORIA
Entity type:Individual
Prefix:MS
First Name:SUHVANNA
Middle Name:VICTORIA
Last Name:LAMAR
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:PO BOX 531852
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33747-1852
Mailing Address - Country:US
Mailing Address - Phone:727-470-1063
Mailing Address - Fax:
Practice Address - Street 1:6933 CROWN LAKE DR
Practice Address - Street 2:
Practice Address - City:GIBSONTON
Practice Address - State:FL
Practice Address - Zip Code:33534-3919
Practice Address - Country:US
Practice Address - Phone:727-470-1063
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-19
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2022064835363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily