Provider Demographics
NPI:1568797108
Name:SHIRLEY, LAUREN (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:
Last Name:SHIRLEY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6015 REX HALL LANE
Mailing Address - Street 2:
Mailing Address - City:APOLLO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33572-4647
Mailing Address - Country:US
Mailing Address - Phone:813-641-0068
Mailing Address - Fax:813-977-1742
Practice Address - Street 1:6015 REX HALL LANE
Practice Address - Street 2:
Practice Address - City:APOLLO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33572-4647
Practice Address - Country:US
Practice Address - Phone:813-641-0068
Practice Address - Fax:813-977-1742
Is Sole Proprietor?:No
Enumeration Date:2009-10-15
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9105202363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant