Provider Demographics
NPI:1811590813
Name:ZEFFARO, LAUREN TRACY WILLS (FNP-BC)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:TRACY WILLS
Last Name:ZEFFARO
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2092 LAKE TAHOE BLVD STE 500
Mailing Address - Street 2:
Mailing Address - City:SOUTH LAKE TAHOE
Mailing Address - State:CA
Mailing Address - Zip Code:96150-6429
Mailing Address - Country:US
Mailing Address - Phone:530-600-2186
Mailing Address - Fax:
Practice Address - Street 1:2092 LAKE TAHOE BLVD STE 500
Practice Address - Street 2:
Practice Address - City:SOUTH LAKE TAHOE
Practice Address - State:CA
Practice Address - Zip Code:96150-6429
Practice Address - Country:US
Practice Address - Phone:530-600-1960
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-20
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95015854363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner