Healthcare Provider Details

I. General information

NPI: 1588498752
Provider Name (Legal Business Name): LAUREN HACKEL APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAUREN CALHOUN

II. Dates (important events)

Enumeration Date: 08/29/2024
Last Update Date: 05/17/2026
Certification Date: 05/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10710 STATE ROAD 54 STE 108
TRINITY FL
34655-2263
US

IV. Provider business mailing address

3036 RAINBOW CT
SAFETY HARBOR FL
34695-5222
US

V. Phone/Fax

Practice location:
  • Phone: 727-376-4040
  • Fax: 727-376-8824
Mailing address:
  • Phone: 954-806-6130
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAPRN11020545
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: