Provider Demographics
NPI:1396000147
Name:JESBERGER, LORI ANN (NP-C)
Entity Type:Individual
Prefix:MS
First Name:LORI
Middle Name:ANN
Last Name:JESBERGER
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815 BUCKEYE LN
Mailing Address - Street 2:
Mailing Address - City:SANDUSKY
Mailing Address - State:OH
Mailing Address - Zip Code:44870-7348
Mailing Address - Country:US
Mailing Address - Phone:419-366-1577
Mailing Address - Fax:
Practice Address - Street 1:800 E BROWARD BLVD STE 400
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33301-2033
Practice Address - Country:US
Practice Address - Phone:419-668-4851
Practice Address - Fax:419-663-5146
Is Sole Proprietor?:No
Enumeration Date:2012-07-09
Last Update Date:2019-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.13454-NP363LF0000X
OHRN.311775-COA1363LF0000X
FLAPRN11000966363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily