Healthcare Provider Details

I. General information

NPI: 1275490088
Provider Name (Legal Business Name): LAUREN BISSETTE
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/06/2026
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

87009 PROFESSIONAL WAY
YULEE FL
32097-3400
US

IV. Provider business mailing address

331 CLAREMONT DR
YULEE FL
32097-0182
US

V. Phone/Fax

Practice location:
  • Phone: 855-444-5664
  • Fax:
Mailing address:
  • Phone: 919-285-8489
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: