Healthcare Provider Details

I. General information

NPI: 1952509796
Provider Name (Legal Business Name): LAUREN CAMERON FISKE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2007
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 NW 35TH AVE
OCALA FL
34475
US

IV. Provider business mailing address

PO BOX 100289
GAINESVILLE FL
32610-0277
US

V. Phone/Fax

Practice location:
  • Phone: 352-280-7400
  • Fax:
Mailing address:
  • Phone: 352-273-9804
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberME164605
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number0101248979
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number2023-02804
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number0451616
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: