Basic Information
| Provider Information | |||||||||
| NPI: | 1255329181 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FARMER | ||||||||
| FirstName: | LORI | ||||||||
| MiddleName: | SHOLDERS | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | ARNP,MS,MSN,AGN-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1545 AIRPORT BLVD | ||||||||
| Address2: | SACRED HEART MEDICAL ONCOLOGY GENETICS | ||||||||
| City: | PENSACOLA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 32504 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8505654399 | ||||||||
| FaxNumber: | 8504162401 | ||||||||
| Practice Location | |||||||||
| Address1: | 1545 AIRPORT BLVD | ||||||||
| Address2: | |||||||||
| City: | PENSACOLA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 32504 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8504166933 | ||||||||
| FaxNumber: | 8504162401 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/13/2005 | ||||||||
| LastUpdateDate: | 01/07/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 125223 | NC | N | Nursing Service Providers | Registered Nurse | 163W00000X | ADV PRACT GENETICS | NC | N | Nursing Service Providers | Registered Nurse | 363L00000X | 1571192 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 170300000X | N | Other Service Providers | Genetic Counselor, MS |
ID Information
| ID | Type | State | Issuer | Description | 1571192 | 01 | FL | ARNP | OTHER |