Provider Demographics
NPI:1598410193
Name:HITSELBERGER, LAURA ANN (APRN)
Entity Type:Individual
Prefix:MS
First Name:LAURA
Middle Name:ANN
Last Name:HITSELBERGER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31041 SUMMER SUN LOOP
Mailing Address - Street 2:
Mailing Address - City:WESLEY CHAPEL
Mailing Address - State:FL
Mailing Address - Zip Code:33545-5166
Mailing Address - Country:US
Mailing Address - Phone:609-577-3205
Mailing Address - Fax:
Practice Address - Street 1:4308 N HABANA AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-6316
Practice Address - Country:US
Practice Address - Phone:813-490-9495
Practice Address - Fax:813-874-0099
Is Sole Proprietor?:No
Enumeration Date:2022-02-14
Last Update Date:2022-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11015179363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily