Healthcare Provider Details

I. General information

NPI: 1366417867
Provider Name (Legal Business Name): LORRAINE M PELLETIER P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5900 COLLEGE RD
KEY WEST FL
33040-4342
US

IV. Provider business mailing address

PO BOX 550968
TAMPA FL
33655-0968
US

V. Phone/Fax

Practice location:
  • Phone: 305-294-5531
  • Fax:
Mailing address:
  • Phone: 800-377-8721
  • Fax: 304-523-2241

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberPA1908
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA1908
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: