Provider Demographics
NPI:1942752134
Name:MASTERS, LAUREN CHANDLER (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:CHANDLER
Last Name:MASTERS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12670 CREEKSIDE LN STE 202
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33919-3370
Mailing Address - Country:US
Mailing Address - Phone:239-482-2663
Mailing Address - Fax:239-689-3625
Practice Address - Street 1:8350 RIVERWALK PARK BLVD STE 1
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33919-8759
Practice Address - Country:US
Practice Address - Phone:239-482-5399
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-04
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9338845363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL019408800Medicaid
FLP982402OtherOPTIMUM
FL1418064OtherWELLCARE
FL5797860OtherAETNA
FLEM40ZOtherBCBS
FLP1049919OtherFREEDOM
FLP01780614OtherRR MEDICARE
FLP982402OtherOPTIMUM
FLIV165ZMedicare PIN