Provider Demographics
NPI:1427693175
Name:VIRGILIO, LORI LEANNE (FNP)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:LEANNE
Last Name:VIRGILIO
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2113 GOVERNMENT ST STE I4
Mailing Address - Street 2:
Mailing Address - City:OCEAN SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:39564-3953
Mailing Address - Country:US
Mailing Address - Phone:228-236-6078
Mailing Address - Fax:
Practice Address - Street 1:2113 GOVERNMENT ST
Practice Address - Street 2:
Practice Address - City:OCEAN SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:39564-3954
Practice Address - Country:US
Practice Address - Phone:228-818-0025
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-16
Last Update Date:2020-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS903776363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily