Provider Demographics
NPI:1619588357
Name:LORMERA, GERMINE
Entity Type:Individual
Prefix:
First Name:GERMINE
Middle Name:
Last Name:LORMERA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1613 SW MERIDIAN AVE
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34953-4300
Mailing Address - Country:US
Mailing Address - Phone:954-864-9098
Mailing Address - Fax:
Practice Address - Street 1:1613 SW MERIDIAN AVE
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34953-4300
Practice Address - Country:US
Practice Address - Phone:954-864-9098
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-16
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376G00000XNursing Service Related ProvidersNursing Home AdministratorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL109954800Medicaid