Healthcare Provider Details

I. General information

NPI: 1386275840
Provider Name (Legal Business Name): JAMES WALTER LOFTON III APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/03/2020
Last Update Date: 09/29/2026
Certification Date: 09/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13762 W STATE ROAD 84 STE 136
DAVIE FL
33325-5305
US

IV. Provider business mailing address

13935 S CYPRESS COVE CIR
DAVIE FL
33325-6742
US

V. Phone/Fax

Practice location:
  • Phone: 954-548-1568
  • Fax: 954-827-7945
Mailing address:
  • Phone: 954-548-1568
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11006289
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberXXXXXX
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: