Healthcare Provider Details

I. General information

NPI: 1316010697
Provider Name (Legal Business Name): LORI A BEUCLER ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LORI BRANSCOMB

II. Dates (important events)

Enumeration Date: 11/16/2006
Last Update Date: 01/08/2020
Certification Date: 01/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7420 SR 54
NPR FL
34653
US

IV. Provider business mailing address

12470 TELECOM DR STE 300W
TEMPLE TERRACE FL
33637-0904
US

V. Phone/Fax

Practice location:
  • Phone: 727-484-3981
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3298092
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: