Healthcare Provider Details

I. General information

NPI: 1316902349
Provider Name (Legal Business Name): LORRAINE RIZZO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2006
Last Update Date: 01/10/2024
Certification Date: 01/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5030 MASON CORBIN CT
FORT MYERS FL
33907-4548
US

IV. Provider business mailing address

2675 WINKLER AVE FL 2
FORT MYERS FL
33901-9342
US

V. Phone/Fax

Practice location:
  • Phone: 239-278-0330
  • Fax: 239-278-1345
Mailing address:
  • Phone: 877-856-3774
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN2598492
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: