Provider Demographics
NPI:1740327600
Name:DELISLE, LORI MICHELLE (PA-C)
Entity type:Individual
Prefix:MS
First Name:LORI
Middle Name:MICHELLE
Last Name:DELISLE
Suffix:
Gender:F
Credentials:PA-C
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Mailing Address - Street 1:WEST FLORIDA PAIN MANAGEMENT
Mailing Address - Street 2:603 7TH ST S. SUITE 320
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33701
Mailing Address - Country:US
Mailing Address - Phone:727-553-7313
Mailing Address - Fax:727-584-7429
Practice Address - Street 1:WEST FLORIDA PAIN MANAGEMENT
Practice Address - Street 2:603 7TH ST S. SUITE 320
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701
Practice Address - Country:US
Practice Address - Phone:727-553-7313
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2023-12-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLPA9101174363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE5693YMedicare PIN