Provider Demographics
NPI:1104555119
Name:BACHTEL, LAUREN
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:BACHTEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1715 BRUSH HILL RD
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-4989
Mailing Address - Country:US
Mailing Address - Phone:561-324-0479
Mailing Address - Fax:
Practice Address - Street 1:2452 MAHAN DR STE 101
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-5377
Practice Address - Country:US
Practice Address - Phone:850-877-2126
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-06
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty