Healthcare Provider Details

I. General information

NPI: 1942371885
Provider Name (Legal Business Name): LORAINE GORDON LMT, CNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MRS. LORAINE GIBBS

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 04/10/2023
Certification Date: 04/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

341 JAMES CIR
LAKE ALFRED FL
33850-2753
US

IV. Provider business mailing address

341 JAMES CIR
LAKE ALFRED FL
33850-2753
US

V. Phone/Fax

Practice location:
  • Phone: 863-449-0929
  • Fax:
Mailing address:
  • Phone: 863-449-0929
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA44682
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number52945
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: