MEDICARE: LORI ROSCOE APRN

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	363LA2200X	Adult Health Nurse Practitioner	APRN9485060	FL
2	363LA2200X	Adult Health Nurse Practitioner	RN179490	GA
3	363LA2200X	Adult Health Nurse Practitioner	NP95006810	CA

General Provider Information

NPI Number	:	1578968053
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LORI ROSCOE APRN

Provider Business Mailing Address
First Line	:	1388 KETTNER BLVD UNIT 702
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92101-2774
Country	:	US
Telephone Number	:	404-805-9502
Fax Number	:

Provider Business Practice Location Address
First Line	:	1388 KETTNER BLVD UNIT 702
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92101-2774
Country	:	US
Telephone Number	:	404-805-9502
Fax Number	:

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

Provider Enumeration Date	:	10/27/2014
Last Update Date	:	11/01/2024

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