Provider Demographics
NPI:1558466292
Name:FRUCI, LAURA ANN (NP)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:ANN
Last Name:FRUCI
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1341 W MOCKINGBIRD LN
Mailing Address - Street 2:SUITE 240E
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75247-6913
Mailing Address - Country:US
Mailing Address - Phone:214-638-6600
Mailing Address - Fax:214-638-6618
Practice Address - Street 1:2560 KING ARTHUR BLVD STE 124
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75056-5818
Practice Address - Country:US
Practice Address - Phone:972-999-5265
Practice Address - Fax:972-899-0362
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2012-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX604766363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX188538601Medicaid
TX188538603Medicaid
TX188538604Medicaid
TX188538605Medicaid
TX188538602Medicaid
TX607766OtherLICENSE
NY5276070-1OtherLICENSE
TX188538605Medicaid
TX8K2476Medicare PIN
TX8L3563Medicare PIN
TX607766OtherLICENSE
TX8K0297Medicare PIN