Church, Lara Diane

Church, Lara Diane is an individual health care provider with primary practice located at 141 Hilden Rd Ste 201 Credentialing Department, Ponte Vedra FL 32081-8400. She recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as her primary health care specialty. Church, Lara Diane can be contacted via phone (904) 825-1941.

Contact Information

Primary practice address
141 Hilden Rd Ste 201 Credentialing Department Ponte Vedra FL 32081-8400
Phone: (904) 825-1941
Fax: (904) 829-2850
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X ME105548 Florida

Profile Details

NPI number 1043280449
LBN Legal business name Church, Lara Diane
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jan 26th, 2006
Last updated Dec 27th, 2018 - about 6 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1043280449 NPPES
Florida Other P01431326 RR MEDICARE

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