Provider Demographics
NPI:1730741562
Name:CALCUTTI, LAUREN PAGE (AA)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:PAGE
Last Name:CALCUTTI
Suffix:
Gender:F
Credentials:AA
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:PAGE
Other - Last Name:RUKAMP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6017 CATLIN DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647-2603
Mailing Address - Country:US
Mailing Address - Phone:912-507-0545
Mailing Address - Fax:
Practice Address - Street 1:4211 VAN DYKE RD
Practice Address - Street 2:
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33558-8005
Practice Address - Country:US
Practice Address - Phone:813-443-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-02
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAA519367H00000X
FL519367H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant