Provider Demographics
NPI:1437199726
Name:PARIS, LAURA J (CNM)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:J
Last Name:PARIS
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 NW 179TH AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33029-2817
Mailing Address - Country:US
Mailing Address - Phone:954-447-1446
Mailing Address - Fax:954-241-4147
Practice Address - Street 1:301 NW 179TH AVE STE 102
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33029-2817
Practice Address - Country:US
Practice Address - Phone:954-447-1446
Practice Address - Fax:954-241-4147
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-07
Last Update Date:2018-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1099732363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL301683800Medicaid
FL301683800Medicaid
FLY8380WMedicare PIN
FLY8380UMedicare PIN
FLY8380VMedicare PIN
FLY8380XMedicare PIN
FLY8380YMedicare PIN