Provider Demographics
NPI:1487201059
Name:STANDRIDGE, LAUREN (FNP-BC)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:STANDRIDGE
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 ORCHARD DR
Mailing Address - Street 2:
Mailing Address - City:FORT SALONGA
Mailing Address - State:NY
Mailing Address - Zip Code:11768-2634
Mailing Address - Country:US
Mailing Address - Phone:631-875-8123
Mailing Address - Fax:
Practice Address - Street 1:1723 N OCEAN AVE STE A
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:NY
Practice Address - Zip Code:11763-2687
Practice Address - Country:US
Practice Address - Phone:631-758-5858
Practice Address - Fax:631-447-6372
Is Sole Proprietor?:No
Enumeration Date:2019-08-19
Last Update Date:2021-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF344520-01363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily