Basic Information
| Provider Information | |||||||||
| NPI: | 1972843035 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NGUYEN | ||||||||
| FirstName: | LAUREN | ||||||||
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| Credential: | ARNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 61 DOLPHIN DR | ||||||||
| Address2: | |||||||||
| City: | TREASURE ISLAND | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337063113 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7279540671 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 61 DOLPHIN DR | ||||||||
| Address2: | |||||||||
| City: | TREASURE ISLAND | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337063113 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7279540671 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/26/2013 | ||||||||
| LastUpdateDate: | 01/23/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2200X | ARNP9258747 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
No ID Information.