Provider Demographics
NPI:1871733428
Name:HARRIS, LAUREN B (PA-C)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:B
Last Name:HARRIS
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 1:19964 E HILLTOP RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80134-7315
Mailing Address - Country:US
Mailing Address - Phone:303-841-2212
Mailing Address - Fax:303-841-4716
Practice Address - Street 1:1800 W HIBISCUS BLVD STE 101
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-2624
Practice Address - Country:US
Practice Address - Phone:321-726-1600
Practice Address - Fax:321-726-1610
Is Sole Proprietor?:No
Enumeration Date:2009-02-23
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9110921363AM0700X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL462789854OtherTAX ID