Provider Demographics
NPI:1598588931
Name:MENARD, LUBERTINA
Entity type:Individual
Prefix:
First Name:LUBERTINA
Middle Name:
Last Name:MENARD
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 1:2598 E SUNRISE BLVD STE 2104
Mailing Address - Street 2:
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33304-3230
Mailing Address - Country:US
Mailing Address - Phone:305-813-5330
Mailing Address - Fax:
Practice Address - Street 1:2598 E SUNRISE BLVD STE 2104
Practice Address - Street 2:
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33304-3230
Practice Address - Country:US
Practice Address - Phone:305-813-5330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-04
Last Update Date:2024-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL240043372600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion