Healthcare Provider Details

I. General information

NPI: 1487110706
Provider Name (Legal Business Name): LAUREN ROSS APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/11/2019
Last Update Date: 02/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1124 BAYVIEW DR
FORT LAUDERDALE FL
33304-2505
US

IV. Provider business mailing address

6779 NW 62ND TER
PARKLAND FL
33067-1427
US

V. Phone/Fax

Practice location:
  • Phone: 954-567-1006
  • Fax:
Mailing address:
  • Phone: 954-682-7365
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11000406
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: