Provider Demographics
NPI:1417493156
Name:HARIHARAN, LAUREN J (PA-C)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:J
Last Name:HARIHARAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8090 HOBBES WAY
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33418-6071
Mailing Address - Country:US
Mailing Address - Phone:321-271-9743
Mailing Address - Fax:
Practice Address - Street 1:24231 WALDEN CENTER DR STE 201
Practice Address - Street 2:
Practice Address - City:ESTERO
Practice Address - State:FL
Practice Address - Zip Code:34134-5012
Practice Address - Country:US
Practice Address - Phone:239-348-4221
Practice Address - Fax:239-390-2486
Is Sole Proprietor?:No
Enumeration Date:2017-01-18
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3195363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL109267400Medicaid
FLNF116OtherMEDICARE
TN103I974348Medicare PIN