Provider Demographics
NPI:1750523759
Name:LEVIN, LORI MARIE (LPN)
Entity type:Individual
Prefix:MS
First Name:LORI
Middle Name:MARIE
Last Name:LEVIN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MRS
Other - First Name:LORI
Other - Middle Name:MARIE
Other - Last Name:D'AMBRA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7300 SUN ISLAND DR S
Mailing Address - Street 2:UNIT 305
Mailing Address - City:SOUTH PASADENA
Mailing Address - State:FL
Mailing Address - Zip Code:33707-4483
Mailing Address - Country:US
Mailing Address - Phone:727-289-1112
Mailing Address - Fax:
Practice Address - Street 1:7300 SUN ISLAND DR S
Practice Address - Street 2:UNIT 305
Practice Address - City:SOUTH PASADENA
Practice Address - State:FL
Practice Address - Zip Code:33707-4483
Practice Address - Country:US
Practice Address - Phone:727-289-1112
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-06
Last Update Date:2009-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY257375-1164W00000X
FLPN 5179495164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse