Healthcare Provider Details

I. General information

NPI: 1164937959
Provider Name (Legal Business Name): LAUREN MARIE COREY CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/03/2017
Last Update Date: 07/24/2025
Certification Date: 07/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

507 CAPE CORAL PKWY E
CAPE CORAL FL
33904-8545
US

IV. Provider business mailing address

PO BOX 2147
FORT MYERS FL
33902-2147
US

V. Phone/Fax

Practice location:
  • Phone: 239-541-4420
  • Fax: 239-468-7908
Mailing address:
  • Phone: 239-541-4420
  • Fax: 239-468-7908

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP018217
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11035203
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: