MEDICARE: LORI GRANT PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	9102171	FL

General Provider Information

NPI Number	:	1548002215
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LORI GRANT PA

Provider Business Mailing Address
First Line	:	2360 ANGUILLA DR UNIT 202
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34120-3969
Country	:	US
Telephone Number	:	239-272-9113
Fax Number	:

Provider Business Practice Location Address
First Line	:	1575 PINE RIDGE RD STE 7
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34109-2108
Country	:	US
Telephone Number	:	239-272-9113
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/12/2024
Last Update Date	:	06/12/2024

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Directions to “ LORI GRANT PA” Practice Location

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