Provider Demographics
NPI:1093955023
Name:ELLIOTT, LAURA LORRAINE (FNP)
Entity Type:Individual
Prefix:MS
First Name:LAURA
Middle Name:LORRAINE
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1625 W INA RD
Mailing Address - Street 2:STE 123
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85704-1975
Mailing Address - Country:US
Mailing Address - Phone:520-955-3061
Mailing Address - Fax:520-204-1474
Practice Address - Street 1:17 W WETMORE RD STE 100
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85705-0600
Practice Address - Country:US
Practice Address - Phone:520-955-3061
Practice Address - Fax:520-204-1474
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-03
Last Update Date:2016-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP3289363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily