Provider Demographics
NPI:1104354653
Name:BAHL, LAUREN ANN (MS, PA-C)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:ANN
Last Name:BAHL
Suffix:
Gender:F
Credentials:MS, PA-C
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:ANN
Other - Last Name:DUGGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, PA-C
Mailing Address - Street 1:2501 N ORANGE AVE STE 401
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32804-4644
Mailing Address - Country:US
Mailing Address - Phone:407-303-7283
Mailing Address - Fax:407-303-0347
Practice Address - Street 1:601 E ROLLINS ST
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-1248
Practice Address - Country:US
Practice Address - Phone:407-303-7283
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-30
Last Update Date:2024-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601008227363A00000X
FLPA9110535363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant