Provider Demographics
NPI:1619007002
Name:LORD, CORY (ARNP)
Entity Type:Individual
Prefix:
First Name:CORY
Middle Name:
Last Name:LORD
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
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Mailing Address - Street 1:1225 HAVENDALE BLVD NW
Mailing Address - Street 2:APT 338
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33881-1393
Mailing Address - Country:US
Mailing Address - Phone:863-268-2921
Mailing Address - Fax:863-268-2923
Practice Address - Street 1:130 PABLO ST
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33803-3818
Practice Address - Country:US
Practice Address - Phone:863-284-5941
Practice Address - Fax:863-284-5199
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2016-10-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLARNP2962462163W00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse