Healthcare Provider Details

I. General information

NPI: 1669927943
Provider Name (Legal Business Name): LEAMARIE LORD FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2016
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

417 SAINT JOHNS AVE
PALATKA FL
32177-4724
US

IV. Provider business mailing address

417 SAINT JOHNS AVE
PALATKA FL
32177-4724
US

V. Phone/Fax

Practice location:
  • Phone: 352-719-0700
  • Fax: 352-719-0719
Mailing address:
  • Phone: 352-719-0700
  • Fax: 352-719-0719

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number9391305
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: