Provider Demographics
NPI:1972070183
Name:LAZARRE, ROLANDE ANTOINE
Entity type:Individual
Prefix:
First Name:ROLANDE
Middle Name:ANTOINE
Last Name:LAZARRE
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 1:5099 NW FIDDLE LEAF CT
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34986-4380
Mailing Address - Country:US
Mailing Address - Phone:772-940-1697
Mailing Address - Fax:772-237-4155
Practice Address - Street 1:5099 NW FIDDLE LEAF CT
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34986-4380
Practice Address - Country:US
Practice Address - Phone:772-940-1697
Practice Address - Fax:772-237-4155
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-25
Last Update Date:2018-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)