Provider Demographics
NPI:1053797860
Name:MCCURDY, LAUREN D (PA)
Entity type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:D
Last Name:MCCURDY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MS
Other - First Name:LAUREN
Other - Middle Name:D
Other - Last Name:RODRIGUEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:3000 MEDICAL PARK DR STE 320
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33613-4681
Mailing Address - Country:US
Mailing Address - Phone:813-910-0027
Mailing Address - Fax:
Practice Address - Street 1:3000 MEDICAL PARK DR STE 320
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-4681
Practice Address - Country:US
Practice Address - Phone:813-910-0027
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-04
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9109099363AS0400X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL015865400Medicaid
FL015865400Medicaid