Provider Demographics
NPI:1831486752
Name:MCCONEGHY, LAUREN NICOLE (PA-C)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:NICOLE
Last Name:MCCONEGHY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:10246 FALLSGROVE ST
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32836-7502
Mailing Address - Country:US
Mailing Address - Phone:407-352-8553
Mailing Address - Fax:407-351-8412
Practice Address - Street 1:7335 W SAND LAKE RD
Practice Address - Street 2:SUITE 200
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-5538
Practice Address - Country:US
Practice Address - Phone:407-352-8553
Practice Address - Fax:407-351-8412
Is Sole Proprietor?:No
Enumeration Date:2011-06-29
Last Update Date:2017-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9105917363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical