=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710930649
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LORI R ESAREY ARNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/19/2006
-----------------------------------------------------
Last Update Date | 04/12/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1585 SANTA BARBARA BLVD. STE B
-----------------------------------------------------
City | THE VILLAGES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32159
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-259-5190
-----------------------------------------------------
Fax | 352-669-9478
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1585 SANTA BARBARA BLVD. STE B
-----------------------------------------------------
City | THE VILLAGES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32159
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-259-5190
-----------------------------------------------------
Fax | 352-669-9478
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | ARNP2619882
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------