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NPI Code Detail

MEDICARE: LAUREN PETERSON

MEDICARE: LAUREN PETERSON
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1171W00000XContractor

General Provider Information

NPI Number : 1063746733
Entity Type Code : Individual
Provider Name (Legal Business Name) : LAUREN PETERSON
Provider Business Mailing Address
First Line : 4518 S MANHATTAN AVE
Second Line :
City : TAMPA
State : FL
Zip : 33611-2306
Country : US
Telephone Number : 813-835-4591
Fax Number : 813-832-3427
Provider Business Practice Location Address
First Line : 4518 S MANHATTAN AVE
Second Line :
City : TAMPA
State : FL
Zip : 33611-2306
Country : US
Telephone Number : 813-835-4591
Fax Number : 813-832-3427
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/28/2009
Last Update Date : 09/28/2009

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Directions to “ LAUREN PETERSON ” Practice Location

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