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MAGNOLIA ADULT
NPI 1033477567
Nurse Practitioner - Adult Health in Lake City, FL

Active since May 03, 2012
1140 SW BASCOM NORRIS DR STE 105, LAKE CITY, FL 32025(386) 755-3300(386) 755-8595 Get Directions Write a Review

NPPES record last updated: May 3, 2012. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Magnolia Adult NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MAGNOLIA ADULT (NPI 1033477567) is a healthcare organization registered as an adult health in Lake City, Florida and active in the NPI registry since May 2012. The organization lists Ira D Lee, President, as its authorized official.

NPPES Registry Identity

NPI1033477567
Entity TypeOrganization
Primary Taxonomy363LA2200X
Legal Business NameMAGNOLIA ADULT
Location Address1140 SW BASCOM NORRIS DR STE 105Lake City, FL 32025-1329
Mailing Address1140 Sw Bascom Norris Dr Ste 105Lake City, FL 32025-1329 · (386) 755-3300 · Fax (386) 755-8595
Phone(386) 755-3300
Fax(386) 755-8595
Organization SubpartNo
Authorized OfficialIra D LeePresident · (386) 755-3300
Enumeration DateMay 3, 2012
✔ NPI 1033477567 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · Adult HealthPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LA2200X
License✔ Licensed in FL · ARNP3091702
1140 SW BASCOM NORRIS DR STE 105, Lake City, FL 32025
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Other Identifiers 1

Medicaid305351200FL

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Magnolia Adult's NPI number?

The NPI number for Magnolia Adult is 1033477567. It was assigned to this organization in the NPPES registry on May 3, 2012.

Where is Magnolia Adult located?

Magnolia Adult is located at 1140 SW Bascom Norris Dr Ste 105, Lake City, FL 32025. The listed phone number is (386) 755-3300.

What is Magnolia Adult's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Adult Health, with taxonomy code 363LA2200X.

When was this NPI record last updated?

The NPPES record for Magnolia Adult was last updated on May 3, 2012. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 14 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.