Provider Demographics
NPI:1528222064
Name:LOFTIS, LAUREN NICOLE (MD)
Entity Type:Individual
Prefix:DR
First Name:LAUREN
Middle Name:NICOLE
Last Name:LOFTIS
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:2400 N COURTENAY PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:MERRITT ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32953-4127
Mailing Address - Country:US
Mailing Address - Phone:321-985-9097
Mailing Address - Fax:321-406-9137
Practice Address - Street 1:465 MINUTEMEN CSWY UNIT 455
Practice Address - Street 2:
Practice Address - City:COCOA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32931-2826
Practice Address - Country:US
Practice Address - Phone:321-985-9097
Practice Address - Fax:321-301-4869
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-14
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO48624207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO27841OtherSTATE ID
COE41160OtherUPIN
COE41160OtherUPIN
COP8508Medicare UPIN