Healthcare Provider Details

I. General information

NPI: 1023390895
Provider Name (Legal Business Name): MS. LAUREN MICHELE WARD-BROCKWAY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2011
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3793 PIONEER TRAILS BLVD E
LAKELAND FL
33810-3518
US

IV. Provider business mailing address

3793 PIONEER TRAILS BLVD E
LAKELAND FL
33810-3518
US

V. Phone/Fax

Practice location:
  • Phone: 407-866-9023
  • Fax:
Mailing address:
  • Phone: 407-866-9023
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA53070
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code172M00000X
TaxonomyMechanotherapist
License NumberMA53070
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: