Basic Information
Provider Information
NPI: 1003152166
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: FREED
FirstName: LAUREN
MiddleName: E
NamePrefix:  
NameSuffix:  
Credential: CRNA
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 4500 SAN PABLO RD S
Address2:  
City: JACKSONVILLE
State: FL
PostalCode: 322241865
CountryCode: US
TelephoneNumber: 9049532000
FaxNumber:  
Practice Location
Address1: 4500 SAN PABLO RD S
Address2:  
City: JACKSONVILLE
State: FL
PostalCode: 322241865
CountryCode: US
TelephoneNumber: 9049532000
FaxNumber:  
Other Information
ProviderEnumerationDate: 12/18/2012
LastUpdateDate: 08/14/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
367500000XARNP9482434FLY Physician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered 
367500000XCOA.14214OHN Physician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered 

No ID Information.


Home