Provider Demographics
NPI:1437118080
Name:HANKE, LAURA L (ARNP)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:L
Last Name:HANKE
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 1:1265 36TH STREET
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-6574
Mailing Address - Country:US
Mailing Address - Phone:772-567-6340
Mailing Address - Fax:772-567-3564
Practice Address - Street 1:1265 36TH STREET
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-6574
Practice Address - Country:US
Practice Address - Phone:772-567-6340
Practice Address - Fax:772-567-3564
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-22
Last Update Date:2019-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLNP2831342363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL304614100Medicaid
FLP64766Medicare UPIN
FL304614100Medicaid