Provider Demographics
NPI:1174025134
Name:RITZ, LAUREN ELIZABETH (PA-C)
Entity type:Individual
Prefix:MS
First Name:LAUREN
Middle Name:ELIZABETH
Last Name:RITZ
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 1:16646 CODY CREEK CT
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32226-0100
Mailing Address - Country:US
Mailing Address - Phone:540-931-8142
Mailing Address - Fax:
Practice Address - Street 1:2790 GODWIN BLVD STE 360
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23434-8153
Practice Address - Country:US
Practice Address - Phone:757-934-4821
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-06
Last Update Date:2024-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA103TS0200X
FLPA9118930363AM0700X
363AM0700X
VA0110010386363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1174025134Medicaid