Healthcare Provider Details

I. General information

NPI: 1962023689
Provider Name (Legal Business Name): LAUREN SPOENEMAN HAYNES PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LAUREN MARGARET SPOENEMAN PA-C

II. Dates (important events)

Enumeration Date: 05/04/2020
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PSC 475 BOX 1
FPO AP
96350-1200
US

IV. Provider business mailing address

PSC 475 BOX 1
FPO AP
96350-1200
US

V. Phone/Fax

Practice location:
  • Phone: 819-565-0362
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number9120541
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: