Individual
MISS LORA JEAN PETERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1697 KINGS RD, JACKSONVILLE, FL 32209-6169
(904) 478-5483
Mailing address
15555 SPOTTED SADDLE CIR, JACKSONVILLE, FL 32218-7984
(510) 875-9909
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA9114289
FL
Other
Enumeration date
07/17/2023
Last updated
07/17/2023
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