Provider Demographics
NPI:1508527391
Name:TROTTER, LAUREN C
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:C
Last Name:TROTTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4510 FERRYS MILL PL
Mailing Address - Street 2:
Mailing Address - City:ELLENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34222-7300
Mailing Address - Country:US
Mailing Address - Phone:941-315-5906
Mailing Address - Fax:
Practice Address - Street 1:4510 FERRYS MILL PL
Practice Address - Street 2:
Practice Address - City:ELLENTON
Practice Address - State:FL
Practice Address - Zip Code:34222-7300
Practice Address - Country:US
Practice Address - Phone:941-315-5906
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-04
Last Update Date:2023-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL114547400Medicaid