Healthcare Provider Details

I. General information

NPI: 1992655914
Provider Name (Legal Business Name): LAUREN ALLEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2026
Last Update Date: 04/08/2026
Certification Date: 04/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

279 WILLOW GREEN DR
ORANGE PARK FL
32073-2262
US

IV. Provider business mailing address

279 WILLOW GREEN DR
ORANGE PARK FL
32073-2262
US

V. Phone/Fax

Practice location:
  • Phone: 850-774-2332
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number9121455
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: