Healthcare Provider Details

I. General information

NPI: 1780180869
Provider Name (Legal Business Name): LAUREN JOY FARLEY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2018
Last Update Date: 09/17/2024
Certification Date: 09/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4645 NW 8TH AVE
GAINESVILLE FL
32605-4524
US

IV. Provider business mailing address

720 AVOCADO DR
MERRITT ISLAND FL
32953-4319
US

V. Phone/Fax

Practice location:
  • Phone: 352-375-1212
  • Fax: 352-371-4650
Mailing address:
  • Phone:
  • 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 Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberME168576
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: