Individual provider Active NPI

Lauren R Ellicott, APRN

  • Adult Health Nurse Practitioner
  • Orlando, FL
National Provider Identifier
1306218656
Registry record updated Aug 21, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
License
APRN11017239 Issued in FL
Practice address
1222 S Orange Ave
Orlando, FL 32806-1215
Phone
(321) 841-6444
Fax
(407) 650-1307
NPI assigned
Oct 27, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 21, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Nurse Specialist 364S00000X 364S00000X OH
Adult Health Nurse Practitioner 363LA2200X APRN11017239 FL Primary

Addresses

Primary practice location

1222 S Orange Ave
Orlando, FL 32806-1215

Mailing address

1222 S Orange Ave
Orlando, FL 32806-1215
Phone (321) 841-6444

Other practice location 1

400 Celebration Pl Ste A280
Celebration, FL 34747-4970
Phone (407) 425-1566

Other names 1

  • Lauren Wallace Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220502000033 FL Practitioner - Nurse Practitioner 9335422757 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Florida Hospital Medical Group IncGroup PAC ID 0749186153, 1,735 clinicians

Practice addresses (Care Compare)

2600 Westhall LN
Maitland, FL 32751-7102
Phone (407) 200-2700

400 Celebration PL
Celebration, FL 34747-4970

Hospital & facility affiliations

  • Adventhealth Orlando Hospital, Orlando, FL, CCN 100007
  • Adventhealth Heart of Florida Hospital, Davenport, FL, CCN 100137

Merit-based Incentive Payment System (MIPS)

Final score
79.91 of 100Reported as group
Quality
61.18
Promoting interoperability
100
Improvement activities
40
Cost
71.86

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
18342OHMDGeneral Practice Dentistry
APRN11017239FLMDAdult Health Nurse Practitioner
364S00000XOHMDClinical Nurse Specialist

Practice roles

OrganizationSpecialtyStatusNew patients
Orlando Health Medical Group Inc CurrentSince Apr 18, 2022 Accepting new patients
Florida Hospital Medical Group Inc CurrentSince Jun 22, 2025 Accepting new patients
Orlando Health, Inc. Current Accepting new patients
Orlando Health Medical Group Inc CurrentSince Apr 18, 2022 Accepting new patients
Florida Hospital Medical Group Inc CurrentSince Jun 22, 2025 Accepting new patients

Locations

400 Celebration Pl
Ste A280
Kissimmee, FL 34747
Phone (407) 425-1566

2600 Westhall Ln
Ste 4
Maitland, FL 32751
Phone (407) 200-2700

1222 S Orange Ave
Orlando, FL 32806
Phone (407) 649-6907

1414 Kuhl Ave
#38
Orlando, FL 32806
Phone (407) 481-7179

32 W Gore St
Orlando, FL 32806
Phone (321) 841-3820

Networks

  • Freedom Health HMO Network
  • Optimum HealthCare HMO Network

Interoperability endpoints

  • Direct secure messaging: lellicott3011428@adventhealth.direct-ci.com
  • Direct secure messaging: lellicott358446@orlandohealth.medalliesdirect.net

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1445904000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1755734400000",
    "number": "1306218656",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1222 S ORANGE AVE",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328061215",
            "telephone_number": "321-841-6444",
            "fax_number": "407-650-1307"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1222 S ORANGE AVE",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328061215",
            "telephone_number": "321-841-6444",
            "fax_number": "407-650-1307"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "400 Celebration Pl Ste A280",
            "address_purpose": "LOCATION",
            "city": "Celebration",
            "state": "FL",
            "postal_code": "347474970",
            "country_code": "US",
            "telephone_number": "407-425-1566",
            "fax_number": "407-422-0166",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ELLICOTT",
        "first_name": "LAUREN",
        "middle_name": "R",
        "name_prefix": "Ms.",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-10-27",
        "last_updated": "2025-08-21",
        "certification_date": "2025-08-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "364S00000X",
            "taxonomy_group": "",
            "desc": "Clinical Nurse Specialist",
            "state": "OH",
            "license": "364S00000X",
            "primary": false
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "FL",
            "license": "APRN11017239",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LAUREN",
            "last_name": "WALLACE",
            "credential": "MS, RN-BC, ACCNS-AG",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Orlando, FL

Sources for this page

Verify at the official NPI Registry.