Provider Demographics
NPI:1477129047
Name:LORRAINE, ABIGAIL GRACE PELLETIER (MD, MPH)
Entity Type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:GRACE PELLETIER
Last Name:LORRAINE
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1657 TRINITY DR
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32504-5708
Mailing Address - Country:US
Mailing Address - Phone:850-416-2400
Mailing Address - Fax:850-416-2330
Practice Address - Street 1:1657 TRINITY DR
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-5708
Practice Address - Country:US
Practice Address - Phone:850-416-2400
Practice Address - Fax:850-416-2330
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-03
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLTRN33263207V00000X
390200000X
FLME159250207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program