Healthcare Provider Details

I. General information

NPI: 1487224499
Provider Name (Legal Business Name): LAUREN SOREL CLISE APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2021
Last Update Date: 01/18/2023
Certification Date: 01/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

894 E ALTAMONTE DR
ALTAMONTE SPRINGS FL
32701-5002
US

IV. Provider business mailing address

4371 VERONICA S SHOEMAKER BLVD
FORT MYERS FL
33916-2216
US

V. Phone/Fax

Practice location:
  • Phone: 407-834-5151
  • Fax:
Mailing address:
  • Phone: 239-274-8200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11013540
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: