Healthcare Provider Details

I. General information

NPI: 1386632842
Provider Name (Legal Business Name): LOTA LEE LUTHER ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LOTA LEE LUTHER FNP C

II. Dates (important events)

Enumeration Date: 10/10/2005
Last Update Date: 05/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1022 CODY BLUFFS RD
BABSON PARK FL
33827-3700
US

IV. Provider business mailing address

1022 CODY BLUFFS RD
BABSON PARK FL
33827-3700
US

V. Phone/Fax

Practice location:
  • Phone: 863-638-1891
  • Fax:
Mailing address:
  • Phone: 863-638-1891
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberARNP1232572
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: