| Doctor Name: | MRS. LARA RENEE BRALY |
| NPI Number: | 1023358751 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | P.A.-C |
| License Number: | B640536866330 |
| Business Practice Address: | 1920 Verano Dr Suite 101 Haines City, FL - 338448585 |
| Business Phone Number: | 8634224977 |
| Business Fax Number: | 8634227786 |
| Mailing Address: | 5115 N Socrum Loop Rd, Apt 191 LAKELAND |
| State: | FL |
| Postal Code: | 338094288 |
| Phone Number: | 8637389986 |
| Fax Number: | |
| NPI Enumeration Date: | 02/16/2013 |
| NPI Last Update Date: | 02/16/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AM0700X |
| License Number: | B640536866330 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Medical |
| Taxonomy Definition: | |