Provider Demographics
NPI:1184230096
Name:WOODRUFF, LAUREN DAISEY
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:DAISEY
Last Name:WOODRUFF
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4440 NELSON AVE
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34231-7515
Mailing Address - Country:US
Mailing Address - Phone:941-780-5248
Mailing Address - Fax:
Practice Address - Street 1:4440 NELSON AVE
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34231-7515
Practice Address - Country:US
Practice Address - Phone:941-780-5248
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-17
Last Update Date:2020-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist