Provider Demographics
NPI:1225783699
Name:CARDOSO, LAURA M (PA-C)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:M
Last Name:CARDOSO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4281 SW 141ST AVE
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33027-3041
Mailing Address - Country:US
Mailing Address - Phone:786-278-2811
Mailing Address - Fax:
Practice Address - Street 1:4281 SW 141ST AVE
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33027-3041
Practice Address - Country:US
Practice Address - Phone:786-278-2811
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-15
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9115522363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant