Provider Demographics
NPI:1033464326
Name:COLLETTI, LAUREN JOHNSTON (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:JOHNSTON
Last Name:COLLETTI
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:4107 MEDICAL PKWY STE 208
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78756-3729
Mailing Address - Country:US
Mailing Address - Phone:512-980-9861
Mailing Address - Fax:512-599-9124
Practice Address - Street 1:4107 MEDICAL PKWY STE 208
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78756-3729
Practice Address - Country:US
Practice Address - Phone:512-980-9861
Practice Address - Fax:512-599-9124
Is Sole Proprietor?:No
Enumeration Date:2012-07-23
Last Update Date:2020-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP12206363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily