Provider Demographics
NPI:1376769562
Name:STALEY, LAUREN EVERS (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:EVERS
Last Name:STALEY
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:SHANDS PEDIATRIC LIVER TRANSPLANT
Mailing Address - Street 2:PO BOX 100271
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32610-0271
Mailing Address - Country:US
Mailing Address - Phone:352-265-3288
Mailing Address - Fax:352-265-0154
Practice Address - Street 1:1600 SW ARCHER RD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32610-3003
Practice Address - Country:US
Practice Address - Phone:352-265-3288
Practice Address - Fax:352-265-0154
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2011-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60031358363LP0200X
FLARNP9216529363L00000X, 363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL308578300Medicaid
AG234ZMedicare PIN