Healthcare Provider Details

I. General information

NPI: 1831697226
Provider Name (Legal Business Name): LAUREN COLBY HENDRICKS ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2018
Last Update Date: 01/31/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 WHETSTONE PL STE 205
SAINT AUGUSTINE FL
32086-5775
US

IV. Provider business mailing address

406 HEFFERON DR
SAINT AUGUSTINE FL
32084-6516
US

V. Phone/Fax

Practice location:
  • Phone: 904-819-9925
  • Fax:
Mailing address:
  • Phone: 772-633-3257
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberARNP9361337
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License NumberRN9361337
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: