Healthcare Provider Details

I. General information

NPI: 1194268524
Provider Name (Legal Business Name): LAUREN KNOTEN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/03/2016
Last Update Date: 12/16/2024
Certification Date: 12/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7154 MEDICAL CENTER DR
SPRING HILL FL
34608-1329
US

IV. Provider business mailing address

PO BOX 102222
ATLANTA GA
30368-2222
US

V. Phone/Fax

Practice location:
  • Phone: 352-596-1926
  • Fax: 352-597-2154
Mailing address:
  • Phone: 392-748-2002
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9110039
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: