Healthcare Provider Details

I. General information

NPI: 1801202981
Provider Name (Legal Business Name): LAUREN KRISTI TEELE CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAUREN SANDMAIER CRNA

II. Dates (important events)

Enumeration Date: 07/09/2014
Last Update Date: 10/15/2020
Certification Date: 10/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 SAN PABLO RD S
JACKSONVILLE FL
32224-1865
US

IV. Provider business mailing address

4500 SAN PABLO RD S
JACKSONVILLE FL
32224-1865
US

V. Phone/Fax

Practice location:
  • Phone: 904-953-2000
  • Fax:
Mailing address:
  • Phone: 904-953-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number218655
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number104052
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberARNP9489110
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: