Provider Demographics
NPI:1275077307
Name:MEARS, LAURA ALISE (ARNP)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:ALISE
Last Name:MEARS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 E REDSTONE AVE
Mailing Address - Street 2:A
Mailing Address - City:CRESTVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:32539-5766
Mailing Address - Country:US
Mailing Address - Phone:850-475-2668
Mailing Address - Fax:
Practice Address - Street 1:1549 AIRPORT BLVD
Practice Address - Street 2:440
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-2266
Practice Address - Country:US
Practice Address - Phone:850-598-4142
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-08
Last Update Date:2017-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9262917363LA2200X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology