1801179874 NPI number — LORI AIKMAN ARNP

Table of content: LORI AIKMAN ARNP (NPI 1801179874)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801179874 NPI number — LORI AIKMAN ARNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AIKMAN
Provider First Name:
LORI
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
ARNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SHELLENBACK
Provider Other First Name:
LORI
Provider Other Middle Name:
ANNE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1801179874
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/08/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2582 MEADOW LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COCOA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32926-2637
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
321-334-4861
Provider Business Mailing Address Fax Number:
321-204-6983

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
37 N ORANGE AVE STE 500
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ORLANDO
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32801-2438
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
321-334-4861
Provider Business Practice Location Address Fax Number:
321-204-6983
Provider Enumeration Date:
09/26/2011

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LP2300X , with the licence number:  APRN9251763 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)