Provider Demographics
NPI:1720663990
Name:LORD, JERA RYAN (APRN-BC)
Entity type:Individual
Prefix:
First Name:JERA
Middle Name:RYAN
Last Name:LORD
Suffix:
Gender:F
Credentials:APRN-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 SEVEN HILLS DR
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34609-0235
Mailing Address - Country:US
Mailing Address - Phone:352-666-6950
Mailing Address - Fax:
Practice Address - Street 1:8246 RIVER COUNTRY DR
Practice Address - Street 2:
Practice Address - City:WEEKI WACHEE
Practice Address - State:FL
Practice Address - Zip Code:34607-2101
Practice Address - Country:US
Practice Address - Phone:352-684-8637
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-10
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11009533207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine