Individual provider · Type 1 NPI

Deaisa Zhane Bomort

Driver · Lakeland, FL

NPI number 1558035717 Active

Practice location

1836 N Crystal Lake Dr
Lakeland, FL 33801-6576

Call (863) 738-9493 Map

Specialties and licenses

TaxonomyCodeLicense
Driver Primary 172A00000XB563179949530 (FL)

Driver: A person employed to operate a motor vehicle as a carrier of persons or property.

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About NPI 1558035717

Deaisa Zhane Bomort's National Provider Identifier is 1558035717, issued on Aug 2, 2021. The primary taxonomy on file is Driver (172A00000X), and the practice location is in Lakeland, FL. The record was last updated on Aug 2, 2021.