Healthcare Provider Details

I. General information

NPI: 1508476029
Provider Name (Legal Business Name): LAUREN ELIZABETH LINDA CCSH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2020
Last Update Date: 08/10/2020
Certification Date: 08/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1110 AIRPORT BLVD STE B
PENSACOLA FL
32504-8608
US

IV. Provider business mailing address

1110 AIRPORT BLVD STE B
PENSACOLA FL
32504-8608
US

V. Phone/Fax

Practice location:
  • Phone: 850-988-5221
  • Fax: 850-438-1148
Mailing address:
  • Phone: 850-988-5221
  • Fax: 850-438-1149

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246Z00000X
TaxonomyOther Specialist/Technologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: