Provider Demographics
NPI:1497348155
Name:HARGETT, LORA (PA-C)
Entity Type:Individual
Prefix:
First Name:LORA
Middle Name:
Last Name:HARGETT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2422 BELLWYND DR APT 2422
Mailing Address - Street 2:
Mailing Address - City:APEX
Mailing Address - State:NC
Mailing Address - Zip Code:27539-3011
Mailing Address - Country:US
Mailing Address - Phone:813-205-6108
Mailing Address - Fax:
Practice Address - Street 1:1011 W WILLIAMS ST STE 102
Practice Address - Street 2:
Practice Address - City:APEX
Practice Address - State:NC
Practice Address - Zip Code:27502-3979
Practice Address - Country:US
Practice Address - Phone:919-870-8409
Practice Address - Fax:877-622-8953
Is Sole Proprietor?:No
Enumeration Date:2021-02-14
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9113714363A00000X
TNPA0000004359363A00000X
NC0010-10854363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant