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General NPI Number Information
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NPI Number | 1932259579
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Entity Type | Individual
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Provider Name | LORI JEAN FACKLER ARNP
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Gender | Female
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Dates
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Enumeration Date | 01/12/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 4413 NW BLITCHTON RD
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City | OCALA
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State | FL
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Zip | 34482-4056
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Country | US
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Telephone | 352-629-8088
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Fax | 352-629-1962
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Provider Business Mailing Address
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Address Line | 4413 NW BLITCHTON RD
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City | OCALA
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State | FL
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Zip | 34482-4056
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Country | US
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Telephone | 352-629-8088
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Fax | 352-629-1962
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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 | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | ARNP2859962
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License Number State | FL
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