| Organization Name: | MAGNOLIA ADULT |
| NPI Number: | 1033477567 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | IRA D LEE (PRESIDENT) |
| Mailing Address: | 1140 Sw Bascom Norris Dr Ste 105 Lake City |
| State: | FL US |
| Postal Code: | 320251329 |
| Phone Number: | 3867553300 |
| Fax Number: | 3867558595 |
| NPI Enumeration Date: | 05/03/2012 |
| NPI Last Update Date: | 05/03/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LA2200X |
| License Number: | ARNP3091702 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Adult Health |
| Taxonomy Definition: | |