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Deaisa Zhane Bomort
Driver in Lakeland, Florida
NPI 1558035717

Deaisa Zhane Bomort is a Driver based in Lakeland, FL. Deaisa Zhane Bomort practices in Lakeland, FL. The NPI Number for Deaisa Zhane Bomort is 1558035717 and holds a License No. B563179949530 (Florida).

The current practice location address for Deaisa Zhane Bomort is 1836 N Crystal Lake Dr, Lakeland, FL and can be reached out via phone at 863-738-9493.

Location: 1836 N Crystal Lake Dr, Lakeland, FL, 33801-6576
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1558035717
Provider Name
Deaisa Zhane Bomort
Credential
Provider Entity Type
Individual
Gender
Female
Address
1836 N Crystal Lake Dr, Lakeland, FL, 33801-6576
Phone Number
863-738-9493
Fax Number
Provider Enumeration Date
08/02/2021
Last Update Date
03/10/2024
institution
Provider Business Practice Location Address Details
Address
1836 N Crystal Lake Dr
City
Lakeland
State
Florida
Zip
33801-6576
Phone Number
863-738-9493
Fax Number
person
Provider Business Mailing Address Details
Address
1836 N Crystal Lake Dr
City
Lakeland
State
Florida
Zip
33801-6576
Phone Number
863-738-9493
Fax Number
person
Provider's Taxonomy Details 1
Type
Other Service Providers
Classification
Driver
Speciality
-
Taxonomy
172A00000X
License No.
B563179949530 (Florida)
Definition
A person employed to operate a motor vehicle as a carrier of persons or property.
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