Provider Demographics
NPI:1326325721
Name:SIEGEL, LAURIE INEZ (ARNP)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:INEZ
Last Name:SIEGEL
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 1:2307 W BROWARD BLVD
Mailing Address - Street 2:STE 100
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33312-1420
Mailing Address - Country:US
Mailing Address - Phone:954-523-3422
Mailing Address - Fax:954-523-3423
Practice Address - Street 1:1625 SE 3RD AVE
Practice Address - Street 2:SUITE 721
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33316-2521
Practice Address - Country:US
Practice Address - Phone:954-523-3422
Practice Address - Fax:954-523-3423
Is Sole Proprietor?:No
Enumeration Date:2011-11-14
Last Update Date:2017-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1755742363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner