Healthcare Provider Details

I. General information

NPI: 1558066191
Provider Name (Legal Business Name): LAUREN RAE O'LOUGHLIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2023
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 5TH STREET SOUTH
ST PETERSBURG FL
33701
US

IV. Provider business mailing address

600 5TH STREET SOUTH SUITE 3100
ST PETERSBURG FL
33701
US

V. Phone/Fax

Practice location:
  • Phone: 727-767-7061
  • Fax:
Mailing address:
  • Phone: 727-767-7061
  • Fax: 727-767-4420

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME181132
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: