Provider Demographics
NPI:1386275840
Name:LOFTON, JAMES WALTER III (APRN)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:WALTER
Last Name:LOFTON
Suffix:III
Gender:M
Credentials:APRN
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Mailing Address - Street 1:13935 S CYPRESS COVE CIR
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33325-6742
Mailing Address - Country:US
Mailing Address - Phone:954-548-1568
Mailing Address - Fax:
Practice Address - Street 1:13762 W STATE ROAD 84 STE 136
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33325-5305
Practice Address - Country:US
Practice Address - Phone:954-548-1568
Practice Address - Fax:954-827-7945
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-03
Last Update Date:2022-09-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLXXXXXX207Q00000X
261QP2300X
FL11006289363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL108201900Medicaid
FLRN9173671OtherDEPARTMENT OF HEALTH