Healthcare Provider Details

I. General information

NPI: 1659235281
Provider Name (Legal Business Name): LAUREN CISCO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/09/2025
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 NW 13TH ST STE 101A
BOCA RATON FL
33486-2269
US

IV. Provider business mailing address

1001 NW 13TH ST
BOCA RATON FL
33486-2269
US

V. Phone/Fax

Practice location:
  • Phone: 561-300-0600
  • Fax: 561-300-0601
Mailing address:
  • Phone: 561-300-0600
  • Fax: 561-300-0601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberAPRN11047366
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: