Provider Demographics
NPI:1972523496
Name:KONRADY, LORAINE F (ARNP)
Entity Type:Individual
Prefix:
First Name:LORAINE
Middle Name:F
Last Name:KONRADY
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:P.O. BOX 499
Mailing Address - Street 2:
Mailing Address - City:PARRISH
Mailing Address - State:FL
Mailing Address - Zip Code:34219-0499
Mailing Address - Country:US
Mailing Address - Phone:941-708-7669
Mailing Address - Fax:941-708-8893
Practice Address - Street 1:919 53RD AVE E
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34203-4801
Practice Address - Country:US
Practice Address - Phone:941-708-7669
Practice Address - Fax:941-708-8893
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2503232363LP0200X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL305801800Medicaid