Provider Demographics
NPI:1699041368
Name:THOMPSON MASTERS, LORIE ANN (PHYSICIAN ASSISTANT)
Entity type:Individual
Prefix:MS
First Name:LORIE
Middle Name:ANN
Last Name:THOMPSON MASTERS
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
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Mailing Address - Street 1:11474 SW VILLAGE PKWY
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34987-2391
Mailing Address - Country:US
Mailing Address - Phone:772-318-4945
Mailing Address - Fax:772-380-4360
Practice Address - Street 1:11474 SW VILLAGE PKWY
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34987-2391
Practice Address - Country:US
Practice Address - Phone:772-318-4945
Practice Address - Fax:772-380-4360
Is Sole Proprietor?:No
Enumeration Date:2012-03-28
Last Update Date:2024-01-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLPA9101181207N00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No207N00000XAllopathic & Osteopathic PhysiciansDermatology