Provider Demographics
NPI:1235467994
Name:WILSON, LORI D (APRN)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:D
Last Name:WILSON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:LORI
Other - Middle Name:L
Other - Last Name:DOOLIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:3325 S TAMIAMI TRL STE 200
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239-5142
Mailing Address - Country:US
Mailing Address - Phone:941-952-9223
Mailing Address - Fax:941-955-0642
Practice Address - Street 1:3325 S TAMIAMI TRL STE 200
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-5142
Practice Address - Country:US
Practice Address - Phone:941-952-9223
Practice Address - Fax:941-955-0642
Is Sole Proprietor?:No
Enumeration Date:2009-11-18
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11016319363LA2200X
KY1093908364SA2200X
FL11016319363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100114430Medicaid
KYP400035718Medicare PIN