Provider Demographics
NPI:1346592805
Name:RODEN, LAURA (ARNP)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:RODEN
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 1:770 NORTHPOINT PARKWAY
Mailing Address - Street 2:SUITE 102
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33407
Mailing Address - Country:US
Mailing Address - Phone:561-275-7604
Mailing Address - Fax:561-802-5385
Practice Address - Street 1:2979 PGA BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-2911
Practice Address - Country:US
Practice Address - Phone:561-275-7604
Practice Address - Fax:561-802-5385
Is Sole Proprietor?:No
Enumeration Date:2012-10-09
Last Update Date:2017-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9247057363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL006792300Medicaid