Provider Demographics
NPI:1174173843
Name:WOOD, LAUREN GENNA (APRN)
Entity type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:GENNA
Last Name:WOOD
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MISS
Other - First Name:LAUREN
Other - Middle Name:GENNA
Other - Last Name:LOCKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:604 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CHATTAHOOCHEE
Mailing Address - State:FL
Mailing Address - Zip Code:32324-1823
Mailing Address - Country:US
Mailing Address - Phone:850-272-6424
Mailing Address - Fax:
Practice Address - Street 1:100 N MAIN ST
Practice Address - Street 2:
Practice Address - City:CHATTAHOOCHEE
Practice Address - State:FL
Practice Address - Zip Code:32324-1198
Practice Address - Country:US
Practice Address - Phone:850-663-7001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-16
Last Update Date:2019-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11004078363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL11004078OtherAPRN LICENSE