Provider Demographics
NPI:1609847177
Name:O'CONNOR, LORI (ARNP)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:O'CONNOR
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 1:875 MILITARY TRL
Mailing Address - Street 2:SUITE 200
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-5700
Mailing Address - Country:US
Mailing Address - Phone:561-746-2411
Mailing Address - Fax:561-746-3770
Practice Address - Street 1:7801 YORK RD STE 102
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-7447
Practice Address - Country:US
Practice Address - Phone:410-769-4920
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-31
Last Update Date:2022-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9382117363LA2200X
MDR149272363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
895L0365OtherMEDICARE PROVIDER NUMBER
Q71856Medicare UPIN
FLID177ZMedicare PIN