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Lacie Manthripragada, PA-C

Physician Assistant in Orlando, FL. Individual provider (NPI-1).

NPI number1982018024
StatusActive
Last updated in NPPESMay 5, 2020

Details

NPI
1982018024
Entity type
Individual (NPI-1)
Name
Lacie Manthripragada
Credential
PA-C
Sex
Female
Sole proprietor
No
Enumeration date
Jun 17, 2014
Certification date
May 5, 2020
Last updated
May 5, 2020

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
363A00000X Physician AssistantPA9112408FLYes
363A00000X Physician AssistantC05294MD

Practice location

615 E Princeton St Ste 101
Orlando, FL 32803-1435

Phone 407-236-0006 · Fax 407-236-0007

Mailing address

615 E Princeton St Ste 101
Orlando, FL 32803-1435

Phone 407-236-0006 · Fax 407-236-0007

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