MEDICARE: LAUREN DICKSON MSN, APRN, FNP-BC

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
1	363L00000X	Nurse Practitioner	11035810	FL

General Provider Information

NPI Number	:	1174342786
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAUREN DICKSON MSN, APRN, FNP-BC

Provider Business Mailing Address
First Line	:	1919 SE 10TH AVE APT 5110
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33316-3177
Country	:	US
Telephone Number	:	925-586-9403
Fax Number	:

Provider Business Practice Location Address
First Line	:	1919 SE 10TH AVE APT 5110
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33316-3177
Country	:	US
Telephone Number	:	925-586-9403
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/09/2024
Last Update Date	:	10/09/2024

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