Provider Demographics
NPI:1497360481
Name:EGGNATZ, LAUREN ANNE (APRN)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:ANNE
Last Name:EGGNATZ
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1725 MONASTERY RD
Mailing Address - Street 2:
Mailing Address - City:ORANGE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32763-6313
Mailing Address - Country:US
Mailing Address - Phone:386-341-6216
Mailing Address - Fax:
Practice Address - Street 1:1725 MONASTERY RD
Practice Address - Street 2:
Practice Address - City:ORANGE CITY
Practice Address - State:FL
Practice Address - Zip Code:32763-6313
Practice Address - Country:US
Practice Address - Phone:386-341-6216
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-15
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11009145207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine