Provider Demographics
NPI:1114106051
Name:LORENZO, GUILLERMO (PA)
Entity Type:Individual
Prefix:MR
First Name:GUILLERMO
Middle Name:
Last Name:LORENZO
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5555 E MICHIGAN ST STE 103
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32822-2700
Mailing Address - Country:US
Mailing Address - Phone:407-456-2977
Mailing Address - Fax:407-745-4688
Practice Address - Street 1:5555 E MICHIGAN ST STE 103
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32822-2700
Practice Address - Country:US
Practice Address - Phone:407-456-2977
Practice Address - Fax:407-745-4688
Is Sole Proprietor?:No
Enumeration Date:2007-10-28
Last Update Date:2020-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9100415364SA2200X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health