Healthcare Provider Details

I. General information

NPI: 1598952947
Provider Name (Legal Business Name): LAUREN BROOKS FAGGARD CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2007
Last Update Date: 07/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 W HERNANDEZ ST
PENSACOLA FL
32501-1815
US

IV. Provider business mailing address

1201 W HERNANDEZ ST
PENSACOLA FL
32501-1815
US

V. Phone/Fax

Practice location:
  • Phone: 850-436-4630
  • Fax:
Mailing address:
  • Phone: 850-436-4630
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number1-094049
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberARNP9319281
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: