Healthcare Provider Details

I. General information

NPI: 1114785169
Provider Name (Legal Business Name): LAUREN ASHLEY CHAPMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/13/2024
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 S ANDREWS AVE
FORT LAUDERDALE FL
33316-2510
US

IV. Provider business mailing address

3107 DENNY RD
NEWARK DE
19702-4803
US

V. Phone/Fax

Practice location:
  • Phone: 954-712-8313
  • Fax:
Mailing address:
  • Phone: 732-857-6198
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number00000000000000
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: