Provider Demographics
NPI:1295316818
Name:AUCOTT, LAUREN MICHELLE (PA-C)
Entity type:Individual
Prefix:MS
First Name:LAUREN
Middle Name:MICHELLE
Last Name:AUCOTT
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 1:1113 W DUERER ST
Mailing Address - Street 2:
Mailing Address - City:EGG HARBOR CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:08215-3112
Mailing Address - Country:US
Mailing Address - Phone:609-214-1409
Mailing Address - Fax:
Practice Address - Street 1:1206 W SHERMAN AVE BLDG 2A
Practice Address - Street 2:
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08360-6911
Practice Address - Country:US
Practice Address - Phone:856-696-9933
Practice Address - Fax:856-696-9939
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-15
Last Update Date:2021-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00616400363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty