Provider Demographics
NPI:1407591613
Name:FITTS, LAUREL NICOLE
Entity Type:Individual
Prefix:
First Name:LAUREL
Middle Name:NICOLE
Last Name:FITTS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1464
Mailing Address - Street 2:
Mailing Address - City:TULLAHOMA
Mailing Address - State:TN
Mailing Address - Zip Code:37388-1464
Mailing Address - Country:US
Mailing Address - Phone:615-707-7368
Mailing Address - Fax:
Practice Address - Street 1:100 E GRIZZARD ST
Practice Address - Street 2:
Practice Address - City:TULLAHOMA
Practice Address - State:TN
Practice Address - Zip Code:37388-3635
Practice Address - Country:US
Practice Address - Phone:615-707-7368
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-02
Last Update Date:2022-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health