Provider Demographics
NPI:1528034006
Name:HUECKSTAEDT, LAURIE ANN (ARNP)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:ANN
Last Name:HUECKSTAEDT
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 1:1311 CENTURY OAK DR
Mailing Address - Street 2:
Mailing Address - City:OCOEE
Mailing Address - State:FL
Mailing Address - Zip Code:34761-4023
Mailing Address - Country:US
Mailing Address - Phone:407-765-5139
Mailing Address - Fax:
Practice Address - Street 1:2831 MAGUIRE RD
Practice Address - Street 2:
Practice Address - City:WINDERMERE
Practice Address - State:FL
Practice Address - Zip Code:34786-6057
Practice Address - Country:US
Practice Address - Phone:407-654-0568
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-24
Last Update Date:2019-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 1521122363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAD376ZMedicare UPIN