Provider Demographics
NPI:1568972180
Name:WOMACK, LAUREN
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:WOMACK
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 1:15260 NW 147TH DR STE 200
Mailing Address - Street 2:
Mailing Address - City:ALACHUA
Mailing Address - State:FL
Mailing Address - Zip Code:32615-5339
Mailing Address - Country:US
Mailing Address - Phone:386-518-0102
Mailing Address - Fax:386-518-0116
Practice Address - Street 1:15260 NW 147TH DR STE 200
Practice Address - Street 2:
Practice Address - City:ALACHUA
Practice Address - State:FL
Practice Address - Zip Code:32615-5339
Practice Address - Country:US
Practice Address - Phone:386-518-0102
Practice Address - Fax:386-518-0116
Is Sole Proprietor?:No
Enumeration Date:2017-10-10
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9361727363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLARNP9361727OtherNURSE PRACTITIONER LICENSE