Healthcare Provider Details

I. General information

NPI: 1811493786
Provider Name (Legal Business Name): LAUREN JENNIFER CAGEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2018
Last Update Date: 06/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3850 BIRD RD STE 701
MIAMI FL
33146
US

IV. Provider business mailing address

3850 BIRD RD STE 701
MIAMI FL
33146-1507
US

V. Phone/Fax

Practice location:
  • Phone: 305-926-6167
  • Fax:
Mailing address:
  • Phone: 305-926-6167
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number9402506
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: