Provider Demographics
NPI:1962882605
Name:JOHNSON, LAUREN (RD, LD/N)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:RD, LD/N
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1756 HOLLYWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-4017
Mailing Address - Country:US
Mailing Address - Phone:407-590-2297
Mailing Address - Fax:
Practice Address - Street 1:5730 LAKE UNDERHILL RD
Practice Address - Street 2:SUITE B
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32807-4366
Practice Address - Country:US
Practice Address - Phone:407-254-1995
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-08
Last Update Date:2015-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND7126133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered