Provider Demographics
NPI:1891004560
Name:TREVEN, LAUREN ANDREA (PA-C)
Entity Type:Individual
Prefix:MS
First Name:LAUREN
Middle Name:ANDREA
Last Name:TREVEN
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 1:3205 E OLIVE RD
Mailing Address - Street 2:APT 80
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32514-7239
Mailing Address - Country:US
Mailing Address - Phone:814-404-2120
Mailing Address - Fax:
Practice Address - Street 1:3205 E OLIVE RD
Practice Address - Street 2:APT 80
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32514-7239
Practice Address - Country:US
Practice Address - Phone:814-404-2120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-29
Last Update Date:2011-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOA002539363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant