Healthcare Provider Details

I. General information

NPI: 1649083999
Provider Name (Legal Business Name): LAUREN M BRANCIFORTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2025
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4401 COLONY VIEW DR
LAKE WORTH FL
33463-7843
US

IV. Provider business mailing address

4401 COLONY VIEW DR
LAKE WORTH FL
33463-7843
US

V. Phone/Fax

Practice location:
  • Phone: 904-334-0910
  • Fax: 561-928-0650
Mailing address:
  • Phone: 904-334-0910
  • Fax: 561-928-0650

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. LAUREN M BRANCIFORTE
Title or Position: OWNER
Credential:
Phone: 904-334-0910