Provider Demographics
NPI:1255329181
Name:FARMER, LORI SHOLDERS (ARNP,MS,MSN,AGN-BC)
Entity Type:Individual
Prefix:MRS
First Name:LORI
Middle Name:SHOLDERS
Last Name:FARMER
Suffix:
Gender:F
Credentials:ARNP,MS,MSN,AGN-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1545 AIRPORT BLVD
Mailing Address - Street 2:SACRED HEART MEDICAL ONCOLOGY GENETICS
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32504
Mailing Address - Country:US
Mailing Address - Phone:850-565-4399
Mailing Address - Fax:850-416-2401
Practice Address - Street 1:1545 AIRPORT BLVD
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504
Practice Address - Country:US
Practice Address - Phone:850-416-6933
Practice Address - Fax:850-416-2401
Is Sole Proprietor?:No
Enumeration Date:2005-10-13
Last Update Date:2016-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC125223163W00000X
NCADV PRACT GENETICS163W00000X
FL1571192363L00000X
170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
No170300000XOther Service ProvidersGenetic Counselor, MS
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1571192OtherARNP