Healthcare Provider Details

I. General information

NPI: 1245740158
Provider Name (Legal Business Name): LAUREN BOND
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2017
Last Update Date: 09/30/2020
Certification Date: 09/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6101 PINE RIDGE RD FL 3
NAPLES FL
34119-3900
US

IV. Provider business mailing address

2675 WINKLER AVE FL 2
FORT MYERS FL
33901-9342
US

V. Phone/Fax

Practice location:
  • Phone: 239-315-7123
  • Fax: 269-315-7122
Mailing address:
  • Phone: 877-856-3774
  • Fax: 239-599-2612

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP9342854
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: