Provider Demographics
NPI:1558498139
Name:CHILDS, LORRAINE M (ARNP)
Entity Type:Individual
Prefix:MS
First Name:LORRAINE
Middle Name:M
Last Name:CHILDS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18005 LINDAWOODS ST
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:FL
Mailing Address - Zip Code:33556-4714
Mailing Address - Country:US
Mailing Address - Phone:727-873-3891
Mailing Address - Fax:727-873-3892
Practice Address - Street 1:6726 HANLEY RD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33634-4739
Practice Address - Country:US
Practice Address - Phone:727-873-3891
Practice Address - Fax:727-873-3892
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2014-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2033182363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner