Provider Demographics
NPI:1649468844
Name:BLAND, LOREN (FNP-C)
Entity type:Individual
Prefix:
First Name:LOREN
Middle Name:
Last Name:BLAND
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:619 S 8TH ST STE 200
Mailing Address - Street 2:
Mailing Address - City:GRIFFIN
Mailing Address - State:GA
Mailing Address - Zip Code:30224-4260
Mailing Address - Country:US
Mailing Address - Phone:770-227-1587
Mailing Address - Fax:770-227-1485
Practice Address - Street 1:619 S 8TH ST STE 200
Practice Address - Street 2:
Practice Address - City:GRIFFIN
Practice Address - State:GA
Practice Address - Zip Code:30224-4260
Practice Address - Country:US
Practice Address - Phone:770-227-1587
Practice Address - Fax:770-227-1485
Is Sole Proprietor?:No
Enumeration Date:2007-10-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN164599NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAP00471136OtherRAILROAD MEDICARE
GAP00471136OtherRAILROAD MEDICARE