Provider Demographics
NPI:1386632842
Name:LUTHER, LOTA LEE (ARNP)
Entity Type:Individual
Prefix:
First Name:LOTA
Middle Name:LEE
Last Name:LUTHER
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:MRS
Other - First Name:LOTA
Other - Middle Name:LEE
Other - Last Name:LUTHER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNP C
Mailing Address - Street 1:1022 CODY BLUFFS RD
Mailing Address - Street 2:
Mailing Address - City:BABSON PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33827-3700
Mailing Address - Country:US
Mailing Address - Phone:863-638-1891
Mailing Address - Fax:
Practice Address - Street 1:1022 CODY BLUFFS RD
Practice Address - Street 2:
Practice Address - City:BABSON PARK
Practice Address - State:FL
Practice Address - Zip Code:33827-3700
Practice Address - Country:US
Practice Address - Phone:863-638-1891
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-10
Last Update Date:2012-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1232572207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL300282900Medicaid
FL300282900Medicaid