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General NPI Number Information
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NPI Number | 1134917222
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Entity Type | Individual
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Provider Name | LORA DIANE NYLUND MSN, APRN
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Gender |
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Dates
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Enumeration Date | 04/28/2025
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Last Update Date | 06/13/2025
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Provider Practice Location Address
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Address Line | 3520 38TH AVE N
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City | ST PETERSBURG
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State | FL
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Zip | 33713-1448
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Country | US
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Telephone | 727-471-5039
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Fax |
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Provider Business Mailing Address
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Address Line | 28744 STORMCLOUD PASS
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City | WESLEY CHAPEL
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State | FL
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Zip | 33543-6424
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Country | US
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Telephone | 901-254-9844
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Fax |
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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 | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | 11038011
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 11038011
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License Number State | FL
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