Provider Demographics
NPI:1235577198
Name:GRACE, LAUREN ELIZABETH (DOM, AP)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:ELIZABETH
Last Name:GRACE
Suffix:
Gender:F
Credentials:DOM, AP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4085 MACEACHEN BLVD
Mailing Address - Street 2:APT 73
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34233-1167
Mailing Address - Country:US
Mailing Address - Phone:941-806-8548
Mailing Address - Fax:
Practice Address - Street 1:2803 FRUITVILLE RD
Practice Address - Street 2:SUITE 142
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34237-5344
Practice Address - Country:US
Practice Address - Phone:941-806-8548
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-12
Last Update Date:2013-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3274171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist