Provider Demographics
NPI:1164937959
Name:COREY, LAUREN MARIE (CRNP)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:MARIE
Last Name:COREY
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2147
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33902-2147
Mailing Address - Country:US
Mailing Address - Phone:239-541-4420
Mailing Address - Fax:239-468-7908
Practice Address - Street 1:507 CAPE CORAL PKWY E
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33904-8545
Practice Address - Country:US
Practice Address - Phone:239-541-4420
Practice Address - Fax:239-468-7908
Is Sole Proprietor?:No
Enumeration Date:2017-12-03
Last Update Date:2025-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP018217363LF0000X
FLAPRN11035203363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
14206276OtherCAQH
FL126665100Medicaid
PA103456980Medicaid