MEDICARE: GERMINE LORMERA

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	376G00000X	Nursing Home Administrator

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1619588357
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GERMINE LORMERA

Provider Business Mailing Address
First Line	:	1613 SW MERIDIAN AVE
Second Line	:
City	:	PORT SAINT LUCIE
State	:	FL
Zip	:	34953-4300
Country	:	US
Telephone Number	:	954-864-9098
Fax Number	:

Provider Business Practice Location Address
First Line	:	1613 SW MERIDIAN AVE
Second Line	:
City	:	PORT ST LUCIE
State	:	FL
Zip	:	34953-4300
Country	:	US
Telephone Number	:	954-864-9098
Fax Number	:

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

Provider Enumeration Date	:	08/16/2020
Last Update Date	:	09/13/2022

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Directions to “ GERMINE LORMERA ” Practice Location

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