Provider Demographics
NPI:1609227586
Name:DAFNIS, ANSLEY LORCH (MD)
Entity Type:Individual
Prefix:DR
First Name:ANSLEY
Middle Name:LORCH
Last Name:DAFNIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ANSLEY
Other - Middle Name:HADDEN
Other - Last Name:LORCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2420 W MISSISSIPPI AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33629-6110
Mailing Address - Country:US
Mailing Address - Phone:813-350-9090
Mailing Address - Fax:813-443-5783
Practice Address - Street 1:1315 S HOWARD AVE STE 102
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33606-3193
Practice Address - Country:US
Practice Address - Phone:813-350-9090
Practice Address - Fax:813-443-5783
Is Sole Proprietor?:No
Enumeration Date:2016-06-22
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLTRN22956207Q00000X
FLME138583207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL103583600Medicaid