Healthcare Provider Details

I. General information

NPI: 1932259579
Provider Name (Legal Business Name): LORI JEAN FACKLER ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/12/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4413 NW BLITCHTON RD
OCALA FL
34482-4056
US

IV. Provider business mailing address

4413 NW BLITCHTON RD
OCALA FL
34482-4056
US

V. Phone/Fax

Practice location:
  • Phone: 352-629-8088
  • Fax: 352-629-1962
Mailing address:
  • Phone: 352-629-8088
  • Fax: 352-629-1962

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberARNP2859962
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: