Provider Demographics
NPI:1619400975
Name:OUDSHOORN, LAURA CHRISTINE (PA)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:CHRISTINE
Last Name:OUDSHOORN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:CHRISTINE
Other - Last Name:HUESGEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2400 PATTERSON ST STE 215
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-6501
Mailing Address - Country:US
Mailing Address - Phone:615-342-7345
Mailing Address - Fax:615-342-7346
Practice Address - Street 1:4125 HUNTERS PARK LN
Practice Address - Street 2:STE. 117
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32837-7615
Practice Address - Country:US
Practice Address - Phone:407-636-7385
Practice Address - Fax:407-681-4603
Is Sole Proprietor?:No
Enumeration Date:2017-04-04
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9110174363AM0700X
TN4319363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical