Provider Demographics
NPI:1598253189
Name:AXFORD, LORI KHRISTINE (NP)
Entity type:Individual
Prefix:MRS
First Name:LORI
Middle Name:KHRISTINE
Last Name:AXFORD
Suffix:
Gender:
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19757 THE PLACE BLVD
Mailing Address - Street 2:
Mailing Address - City:ESTERO
Mailing Address - State:FL
Mailing Address - Zip Code:33928-6608
Mailing Address - Country:US
Mailing Address - Phone:425-971-0900
Mailing Address - Fax:
Practice Address - Street 1:19757 THE PLACE BLVD
Practice Address - Street 2:
Practice Address - City:ESTERO
Practice Address - State:FL
Practice Address - Zip Code:33928-6608
Practice Address - Country:US
Practice Address - Phone:425-971-0900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-29
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9485476363L00000X, 363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty