Healthcare Provider Details

I. General information

NPI: 1992352967
Provider Name (Legal Business Name): LAUREN PALMA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2019
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4801 S CONGRESS AVE STE 400
PALM SPRINGS FL
33461-4746
US

IV. Provider business mailing address

PO BOX 102222
ATLANTA GA
30368-2222
US

V. Phone/Fax

Practice location:
  • Phone: 561-366-4100
  • Fax: 561-439-2717
Mailing address:
  • Phone: 239-274-8200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9121335
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: