Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Lakeland Regional Health System, Inc

Organization Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician · NPI 1114393469

Lakeland Regional Health System, Inc is an Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician in Lakeland, Florida. Registered with an NPI since 2015.

In the registry since
2015
Specialties on file
5
What do these letters mean?
Inc — Incorporated
A form of business registration, not a clinical qualification.

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Practice location Address checks out

3644 Innovation Dr
Lakeland, FL 33812-4105
Phone: (863) 284-1583
Fax: (863) 413-4822
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

General Practice Physician (primary) Taxonomy 208D00000X
Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician Taxonomy 207VF0040X
Multi-Specialty Clinic/Center Taxonomy 261QM1300X
Physician Assistant Taxonomy 363A00000X
Surgical Physician Assistant Taxonomy 363AS0400X

Record details

NPI number1114393469
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Lance Green — Cfo · (863) 687-1100
NPI enumeratedAugust 20, 2015
Last updated in NPPESApril 10, 2023
Certification dateApril 10, 2023
Mailing address1324 Lakeland Hills Blvd, Managed Care Dept, Lakeland, FL 33805

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