Provider Demographics
NPI:1265299010
Name:MAGNANO, LORI (FNP-BC)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:MAGNANO
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1034 EL RIO AVE
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33919-2610
Mailing Address - Country:US
Mailing Address - Phone:239-898-2277
Mailing Address - Fax:
Practice Address - Street 1:19701 S TAMIAMI TRL
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908-4818
Practice Address - Country:US
Practice Address - Phone:844-342-7935
Practice Address - Fax:239-489-5202
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-28
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11031559363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily