Provider Demographics
NPI:1972888360
Name:RICE, LAUREN MARIE (PA-C)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:MARIE
Last Name:RICE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:305 MEMORIAL MEDICAL PKWY
Mailing Address - Street 2:SUITE 205
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32117-5168
Mailing Address - Country:US
Mailing Address - Phone:386-231-3530
Mailing Address - Fax:386-231-3534
Practice Address - Street 1:305 MEMORIAL MEDICAL PKWY
Practice Address - Street 2:SUITE 205
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32117
Practice Address - Country:US
Practice Address - Phone:386-231-3530
Practice Address - Fax:386-231-3534
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-17
Last Update Date:2018-07-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FL9106176363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLFS455ZOtherMEDICARE