Healthcare Provider Details

I. General information

NPI: 1750560033
Provider Name (Legal Business Name): LAUREN A FAMULARO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2007
Last Update Date: 11/02/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1210 S OLD DIXIE HWY
JUPITER FL
33458-7205
US

IV. Provider business mailing address

1613 NW 136TH AVE BUILDING C, SUITE #200 (DEPT 909)
SUNRISE FL
33323-2853
US

V. Phone/Fax

Practice location:
  • Phone: 561-743-5073
  • Fax: 561-743-5074
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberARNP9204972
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: