Provider Demographics
NPI:1003200585
Name:ROERO, LAUREN D (PA-C)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:D
Last Name:ROERO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1065 NE 125TH STREET
Mailing Address - Street 2:SUITE 409
Mailing Address - City:NORTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33161-5834
Mailing Address - Country:US
Mailing Address - Phone:888-852-6672
Mailing Address - Fax:786-235-6225
Practice Address - Street 1:7481 W OAKLAND PARK BOULEVARD
Practice Address - Street 2:SUITE 100
Practice Address - City:LAUDERHILL
Practice Address - State:FL
Practice Address - Zip Code:33319-4985
Practice Address - Country:US
Practice Address - Phone:954-771-7743
Practice Address - Fax:954-771-7748
Is Sole Proprietor?:No
Enumeration Date:2015-03-23
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FL9108595363AM0700X
FLPA9108595363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical