Healthcare Provider Details

I. General information

NPI: 1669908067
Provider Name (Legal Business Name): LAUREN FAYE FANTY MD, MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2017
Last Update Date: 10/24/2022
Certification Date: 10/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SW ARCHER RD
GAINESVILLE FL
32610-4402
US

IV. Provider business mailing address

PO BOX 100236
GAINESVILLE FL
32610-0236
US

V. Phone/Fax

Practice location:
  • Phone: 352-273-5550
  • Fax:
Mailing address:
  • Phone: 352-273-5550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberME149503
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: