Healthcare Provider Details

I. General information

NPI: 1699517722
Provider Name (Legal Business Name): LAUREN FLYNN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2024
Last Update Date: 10/03/2024
Certification Date: 10/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 E 6TH ST STE 505
PANAMA CITY FL
32401-3663
US

IV. Provider business mailing address

4205 BELFORT RD STE 4015
JACKSONVILLE FL
32216-3623
US

V. Phone/Fax

Practice location:
  • Phone: 850-804-3030
  • Fax: 850-804-3035
Mailing address:
  • Phone: 904-450-6063
  • Fax: 904-539-4091

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAPRN11033311
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: