Provider Demographics
NPI:1235421165
Name:LAKES, CLAIRE MARIE (FNP-C)
Entity type:Individual
Prefix:
First Name:CLAIRE
Middle Name:MARIE
Last Name:LAKES
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:MITZI
Other - Middle Name:
Other - Last Name:LAKES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FNP-C
Mailing Address - Street 1:1005 MAR WALT DR
Mailing Address - Street 2:
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32547-6707
Mailing Address - Country:US
Mailing Address - Phone:850-863-8219
Mailing Address - Fax:850-863-8249
Practice Address - Street 1:2001 E HIGHWAY 20
Practice Address - Street 2:
Practice Address - City:NICEVILLE
Practice Address - State:FL
Practice Address - Zip Code:32578-8826
Practice Address - Country:US
Practice Address - Phone:850-897-4400
Practice Address - Fax:850-863-8249
Is Sole Proprietor?:No
Enumeration Date:2011-05-11
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9213390363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003578000Medicaid