Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of October 4, 2026.
NPIDirectory

Lake Neurology Clinic, PA

Organization Specialist · NPI 1700958600

Lake Neurology Clinic, PA provides Specialist services in Leesburg, Florida. Licensed in Florida. Registered with an NPI since 2006.

Licensed in
FL
In the registry since
2006
What do these letters mean?
PA — Professional association
A form of business registration, not a clinical qualification.

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Practice location Address checks out

608 S 9th St Ste A
Leesburg, FL 34748 Not confirmed with CMS for 16 years — call before visiting
Phone: (352) 360-1122
Fax: (352) 360-1123
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Specialist (primary) Taxonomy 174400000X · Licence ME76490 (FL)

Record details

NPI number1700958600
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Marilyn Glover — Office Manager · (352) 360-1122
NPI enumeratedNovember 15, 2006
Last updated in NPPESMarch 5, 2010
Mailing addressPo Box 490123, Leesburg, FL 34749-0123

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