Provider Demographics
NPI:1225232952
Name:FAUQUIER, LORI
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:FAUQUIER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1672 LITTLE RIVER WAY
Mailing Address - Street 2:
Mailing Address - City:PARRISH
Mailing Address - State:FL
Mailing Address - Zip Code:34219
Mailing Address - Country:US
Mailing Address - Phone:941-732-3324
Mailing Address - Fax:
Practice Address - Street 1:11672 LITTLE RIVER WAY
Practice Address - Street 2:
Practice Address - City:PARRISH
Practice Address - State:FL
Practice Address - Zip Code:34219-3233
Practice Address - Country:US
Practice Address - Phone:845-464-4051
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-14
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NN8867700163WW0101X
NYF420560363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No163WW0101XNursing Service ProvidersRegistered NurseWomen's Health Care, Ambulatory
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8630704Medicaid
NJP40913Medicare UPIN