Provider Demographics
NPI:1093759524
Name:SMITH, LORELLE J (ARNP)
Entity Type:Individual
Prefix:MS
First Name:LORELLE
Middle Name:J
Last Name:SMITH
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11479 CORTEZ BLVD
Mailing Address - Street 2:
Mailing Address - City:BROOKSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:34613-7367
Mailing Address - Country:US
Mailing Address - Phone:352-597-3511
Mailing Address - Fax:352-597-3466
Practice Address - Street 1:11479 CORTEZ BLVD
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34613-7367
Practice Address - Country:US
Practice Address - Phone:352-597-3511
Practice Address - Fax:352-597-3466
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN2727382363LA2200X
FLARNP2727382363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPENDINGMedicaid
PENDINGMedicare ID - Type Unspecified