Provider Demographics
NPI:1326561945
Name:PARTLOW, LAURA SUE (ARNP)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:SUE
Last Name:PARTLOW
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:SUE
Other - Last Name:HASTY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:PO BOX 2147
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33902-2147
Mailing Address - Country:US
Mailing Address - Phone:239-424-1900
Mailing Address - Fax:239-424-1904
Practice Address - Street 1:1138 COUNTRY CLUB BLVD
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33990-3027
Practice Address - Country:US
Practice Address - Phone:239-424-1900
Practice Address - Fax:239-424-1904
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-25
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9212792363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL022296400Medicaid
FLARNP9212792OtherLICENSURE
MP4679190OtherDEA LICENSURE