Provider Demographics
NPI:1619546454
Name:PROSTROLLO, LAUREN RUSSELL (DO)
Entity type:Individual
Prefix:DR
First Name:LAUREN
Middle Name:RUSSELL
Last Name:PROSTROLLO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 746638
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-6638
Mailing Address - Country:US
Mailing Address - Phone:904-202-2092
Mailing Address - Fax:904-376-4075
Practice Address - Street 1:4844 DEER LAKE DR W STE 1
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32246-4506
Practice Address - Country:US
Practice Address - Phone:904-738-8690
Practice Address - Fax:904-390-7426
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-24
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLOS20431207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine