Provider Demographics
NPI:1114401379
Name:KARESH, LAUREN (CNP)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:KARESH
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2838 BACCURATE DR
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30062-8711
Mailing Address - Country:US
Mailing Address - Phone:404-281-0904
Mailing Address - Fax:
Practice Address - Street 1:8051 N TAMIAMI TRL STE E6
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34243-2067
Practice Address - Country:US
Practice Address - Phone:404-281-0904
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-23
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.023542363LF0000X
GARN207049363LF0000X
FLAPRN11027875363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily