Provider Demographics
NPI:1669825873
Name:BROLUND, LAUREN ELIZABETH (PA-C)
Entity Type:Individual
Prefix:MS
First Name:LAUREN
Middle Name:ELIZABETH
Last Name:BROLUND
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 1:1000 S ORLANDO AVE
Mailing Address - Street 2:APARTMENT A4
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-6476
Mailing Address - Country:US
Mailing Address - Phone:407-353-4806
Mailing Address - Fax:
Practice Address - Street 1:875 OUTER RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32814-6652
Practice Address - Country:US
Practice Address - Phone:407-895-8818
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-22
Last Update Date:2022-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9109657363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant