Provider Demographics
NPI:1568025898
Name:BURNHAM, LAUREN (APRN)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:BURNHAM
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:PO BOX 2699
Mailing Address - Street 2:ATTN SHMG/HPE
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32513-2699
Mailing Address - Country:US
Mailing Address - Phone:850-416-2550
Mailing Address - Fax:850-416-2539
Practice Address - Street 1:5153 N 9TH AVE STE 205
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-5719
Practice Address - Country:US
Practice Address - Phone:850-416-2550
Practice Address - Fax:850-416-2539
Is Sole Proprietor?:No
Enumeration Date:2019-04-22
Last Update Date:2019-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11002172363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health