Healthcare Provider Details

I. General information

NPI: 1205470218
Provider Name (Legal Business Name): LAUREN ELIZABETH TODD NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2019
Last Update Date: 04/16/2026
Certification Date: 04/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13460 TREDEGAR LAKE PKWY
MIDLOTHIAN VA
23112-4070
US

IV. Provider business mailing address

8135 FOREST LN # 515057
DALLAS TX
75230-2472
US

V. Phone/Fax

Practice location:
  • Phone: 804-264-8782
  • Fax: 804-266-9214
Mailing address:
  • Phone: 804-264-8782
  • Fax: 804-266-9214

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number0024177995
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number0024177995
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number0001247599
License Number StateVA
# 4
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number0024177995
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: