Healthcare Provider Details

I. General information

NPI: 1194113639
Provider Name (Legal Business Name): LAUREN CRAWFORD BREWER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAUREN MICHELE CRAWFORD ARNP

II. Dates (important events)

Enumeration Date: 01/07/2015
Last Update Date: 05/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14550 OLD SAINT AUGUSTINE RD
JACKSONVILLE FL
32258-2460
US

IV. Provider business mailing address

14550 OLD SAINT AUGUSTINE RD
JACKSONVILLE FL
32258-2460
US

V. Phone/Fax

Practice location:
  • Phone: 904-271-6000
  • Fax:
Mailing address:
  • Phone: 904-271-6000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberARNP9303948
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: