Provider Demographics
NPI:1619384310
Name:LAUBACH, KAREN LEE
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:LEE
Last Name:LAUBACH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3501 CORTEZ RD W
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34210-3104
Mailing Address - Country:US
Mailing Address - Phone:941-752-2700
Mailing Address - Fax:941-752-2736
Practice Address - Street 1:3501 CORTEZ RD W
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34210-3104
Practice Address - Country:US
Practice Address - Phone:941-752-2700
Practice Address - Fax:941-752-2736
Is Sole Proprietor?:No
Enumeration Date:2014-07-15
Last Update Date:2021-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9217817 - FL363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily