Provider Demographics
NPI:1245596600
Name:LETIZIA, LAURIE DIANNE (PA-C)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:DIANNE
Last Name:LETIZIA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:LAURIE
Other - Middle Name:DIANNE
Other - Last Name:HUGHES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1111 S SEMORAN BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32807-1442
Mailing Address - Country:US
Mailing Address - Phone:407-201-3686
Mailing Address - Fax:407-201-3739
Practice Address - Street 1:1111 S SEMORAN BLVD STE B
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32807-1442
Practice Address - Country:US
Practice Address - Phone:407-201-3686
Practice Address - Fax:407-201-3739
Is Sole Proprietor?:No
Enumeration Date:2012-04-10
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA006469363A00000X
FL9113371363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant