Provider Demographics
NPI:1932259579
Name:FACKLER, LORI JEAN (ARNP)
Entity type:Individual
Prefix:MRS
First Name:LORI
Middle Name:JEAN
Last Name:FACKLER
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4413 NW BLITCHTON RD
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34482-4056
Mailing Address - Country:US
Mailing Address - Phone:352-629-8088
Mailing Address - Fax:352-629-1962
Practice Address - Street 1:4413 NW BLITCHTON RD
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34482-4056
Practice Address - Country:US
Practice Address - Phone:352-629-8088
Practice Address - Fax:352-629-1962
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2859962363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health