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General NPI Number Information
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NPI Number | 1033319546
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Entity Type | Individual
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Provider Name | LORI ANN ANTHONY
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Gender | Female
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Dates
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Enumeration Date | 07/23/2007
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Last Update Date | 12/19/2016
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Provider Practice Location Address
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Address Line | 142 JOHN F KENNEDY DR
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City | LAKE WORTH
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State | FL
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Zip | 33462-1159
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Country | US
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Telephone | 561-439-1500
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Fax | 561-439-9902
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Provider Business Mailing Address
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Address Line | 2234 COLONIAL BLVD ATTN: PAYER CONTRACTING & RELATIONS DEPT.
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City | FORT MYERS
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State | FL
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Zip | 33907-1412
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Country | US
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Telephone | 239-931-7342
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Fax | 239-931-7385
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA3370
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 364SM0705X
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Taxonomy Name | Medical-Surgical Clinical Nurse Specialist
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License Number | PA3370
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License Number State | FL
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