Lora Jean Peterson, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

PA9114289 Issued in FL

Practice address

1697 Kings Rd
Jacksonville, FL 32209-6169

Phone

(904) 478-5483

NPI assigned

Jul 17, 2023

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Mrs. Lora Peterson Garrett Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1689552000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1689552000000",
    "number": "1487333548",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15555 SPOTTED SADDLE CIR",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322187984",
            "telephone_number": "510-875-9909"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1697 KINGS RD",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322096169",
            "telephone_number": "904-478-5483"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "LORA",
        "middle_name": "JEAN",
        "name_prefix": "Miss",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-07-17",
        "last_updated": "2023-07-17",
        "certification_date": "2023-07-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "FL",
            "license": "PA9114289",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LORA",
            "last_name": "GARRETT",
            "middle_name": "PETERSON",
            "prefix": "MRS.",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Jeffrey Peterson, MD
• Jennifer Peterson, MD
• Jessica A Peterson, PHARMD
• Kevin William Peterson, M.D.
• Kyle William Peterson, MD
• Lynn Peterson
• Mary Peterson, ADMINISTRATOR
• Michael Peterson
• Richard Kenneth Peterson, M.D.
• Ruby D Peterson

• Medical Physician Assistant in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Medical Physician Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.