Provider Demographics
NPI:1306030747
Name:KENSETH, LORRIE M (NP)
Entity Type:Individual
Prefix:
First Name:LORRIE
Middle Name:M
Last Name:KENSETH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:LORRIE
Other - Middle Name:M
Other - Last Name:COFFMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:5191 FIRST COAST TECH PKWY FL 3
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32224-0609
Mailing Address - Country:US
Mailing Address - Phone:904-223-3321
Mailing Address - Fax:904-223-2169
Practice Address - Street 1:2550 PARK ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32204-4518
Practice Address - Country:US
Practice Address - Phone:904-223-3321
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-29
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9341144363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL008170300Medicaid
FLHD572YMedicare PIN
WI60865OtherDEAN HEALTH INSURANCE
WI36041300Medicaid