Basic Information
| Provider Information | |||||||||
| NPI: | 1154385722 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FREITAS | ||||||||
| FirstName: | LORIE | ||||||||
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| Credential: | ARNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 18868 | ||||||||
| Address2: | |||||||||
| City: | PENSACOLA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 325238868 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8509945660 | ||||||||
| FaxNumber: | 8509945841 | ||||||||
| Practice Location | |||||||||
| Address1: | 9400 UNIVERSITY PKWY | ||||||||
| Address2: | SUITE 210 | ||||||||
| City: | PENSACOLA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 325145752 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8509447256 | ||||||||
| FaxNumber: | 8509449330 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/12/2006 | ||||||||
| LastUpdateDate: | 02/23/2011 | ||||||||
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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 | 363LF0000X | ARNP3380102 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 59075380 | 01 | AL | BCBS AL | OTHER | 304322300 | 05 | FL | MEDICAID | Y000L | 01 | FL | BCBSFL | OTHER |