Healthcare Provider Details

I. General information

NPI: 1013801679
Provider Name (Legal Business Name): CONNOR PALMER LORE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2025
Last Update Date: 04/14/2026
Certification Date: 04/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36463 US HIGHWAY 19 N
PALM HARBOR FL
34684-1329
US

IV. Provider business mailing address

36463 US HIGHWAY 19 N
PALM HARBOR FL
34684-1329
US

V. Phone/Fax

Practice location:
  • Phone: 727-786-1673
  • Fax:
Mailing address:
  • Phone: 727-786-1673
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9121222
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: