Provider Demographics
NPI:1609989524
Name:NYREN, LAURA (ARNP)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:NYREN
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 1:1540 S TAMIAMI TRL
Mailing Address - Street 2:SUITE 401
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239-2930
Mailing Address - Country:US
Mailing Address - Phone:941-917-0060
Mailing Address - Fax:941-957-4248
Practice Address - Street 1:1540 S TAMIAMI TRL
Practice Address - Street 2:SUITE 401
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-2930
Practice Address - Country:US
Practice Address - Phone:941-917-0060
Practice Address - Fax:941-957-4248
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2016-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9414213363L00000X
MA194849363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
270894OtherBLUE SHIELD
FLIK137ZMedicare PIN
MA411399OtherMASS BLS
270894OtherBLUE SHIELD
RIP96924Medicare UPIN
270894OtherBLUE SHIELD
RI7010716Medicaid