Healthcare Provider Details

I. General information

NPI: 1417205295
Provider Name (Legal Business Name): ANA PATRICIA LORENZO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2012
Last Update Date: 01/07/2021
Certification Date: 01/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4227 13TH ST
SAINT CLOUD FL
34769-6732
US

IV. Provider business mailing address

5564 E GRANT ST
ORLANDO FL
32822-1666
US

V. Phone/Fax

Practice location:
  • Phone: 321-235-6230
  • Fax: 321-235-6246
Mailing address:
  • Phone: 321-235-6230
  • Fax: 321-235-6246

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME122728
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: