Provider Demographics
NPI:1235147588
Name:HALL, LOIS (ARNP)
Entity Type:Individual
Prefix:
First Name:LOIS
Middle Name:
Last Name:HALL
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 1:1290 GOLFVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:BARTOW
Mailing Address - State:FL
Mailing Address - Zip Code:33830-6740
Mailing Address - Country:US
Mailing Address - Phone:863-519-7900
Mailing Address - Fax:
Practice Address - Street 1:1255 BRICE BLVD
Practice Address - Street 2:
Practice Address - City:BARTOW
Practice Address - State:FL
Practice Address - Zip Code:33830-6735
Practice Address - Country:US
Practice Address - Phone:863-519-7900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2019-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2732712363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL304371100Medicaid
FL304371100Medicaid
FLP70774Medicare UPIN