Provider Demographics
NPI:1275602252
Name:SABLAD, LORIE ANNE (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:LORIE
Middle Name:ANNE
Last Name:SABLAD
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:LORIE
Other - Middle Name:ANNE
Other - Last Name:DAUGHERTY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:4726 ALEXIS DR
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34746-5964
Mailing Address - Country:US
Mailing Address - Phone:321-677-3612
Mailing Address - Fax:
Practice Address - Street 1:5500 MILAN DR
Practice Address - Street 2:ORLANDO
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32810-4405
Practice Address - Country:US
Practice Address - Phone:407-296-6430
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2008-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9246653363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics