MEDICARE: LORI ANN ANTHONY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	PA3370	FL
2	364SM0705X	Medical-Surgical Clinical Nurse Specialist	PA3370	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	01584482	OTHER	FL	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	Y06US	OTHER	FL	BCBS
3	P1035302	OTHER	FL	FREEDOM
4	P971101	OTHER	FL	OPTIMUM
5	9743715	OTHER	FL	AETNA
6	206389	OTHER	FL	AVMED
7	8678245	OTHER	FL	CIGNA

General Provider Information

NPI Number	:	1033319546
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LORI ANN ANTHONY

Provider Business Mailing Address
First Line	:	2234 COLONIAL BLVD
Second Line	:	ATTN: PAYER CONTRACTING & RELATIONS DEPT.
City	:	FORT MYERS
State	:	FL
Zip	:	33907-1412
Country	:	US
Telephone Number	:	239-931-7342
Fax Number	:	239-931-7385

Provider Business Practice Location Address
First Line	:	142 JOHN F KENNEDY DR
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33462-1159
Country	:	US
Telephone Number	:	561-439-1500
Fax Number	:	561-439-9902

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/23/2007
Last Update Date	:	12/19/2016

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Directions to “ LORI ANN ANTHONY ” Practice Location

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