Provider Demographics
NPI:1578968053
Name:ROSCOE, LORI (APRN)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:ROSCOE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1388 KETTNER BLVD UNIT 702
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92101-2774
Mailing Address - Country:US
Mailing Address - Phone:404-805-9502
Mailing Address - Fax:
Practice Address - Street 1:1388 KETTNER BLVD UNIT 702
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92101-2774
Practice Address - Country:US
Practice Address - Phone:404-805-9502
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-27
Last Update Date:2024-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9485060363LA2200X
GARN179490363LA2200X
CANP95006810363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health