Healthcare Provider Details

I. General information

NPI: 1700792892
Provider Name (Legal Business Name): LAUREN ADAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2026
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 REDSTONE AVE W
CRESTVIEW FL
32536-6433
US

IV. Provider business mailing address

200 MIRAGE AVE UNIT 8207
CRESTVIEW FL
32536-5314
US

V. Phone/Fax

Practice location:
  • Phone: 850-689-1740
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: