Provider Demographics
NPI:1053822569
Name:LOFTUS, LORRAINE FRANCES
Entity type:Individual
Prefix:
First Name:LORRAINE
Middle Name:FRANCES
Last Name:LOFTUS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1005 SE 40TH ST APT 9
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33904-5108
Mailing Address - Country:US
Mailing Address - Phone:716-870-2063
Mailing Address - Fax:239-334-0244
Practice Address - Street 1:1005 SE 40TH ST APT 9
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33904-5108
Practice Address - Country:US
Practice Address - Phone:716-870-2063
Practice Address - Fax:239-334-0244
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-24
Last Update Date:2017-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
FL019958800171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL019958800Medicaid