Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0122X | Plastic and Reconstructive Surgery | ME135803 | FL |
NPI | 1174899470 |
---|---|
Provider Name | Dr. Lauren Van Eldik Kuykendall |
First Address | Orlando, FL 32891-0001 |
Second Address | Tampa, FL 33612 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/03/2012 |
Last Update Date | 31/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100668000 | (05) | FL |
JN604 | MEDICARE (01) | FL |
LJM10 | BLUE CROSS BLUE SHIELD (01) | FL |