Provider Demographics
NPI:1619626645
Name:STRAUB, LUISA FERNANDA (APRN)
Entity Type:Individual
Prefix:
First Name:LUISA
Middle Name:FERNANDA
Last Name:STRAUB
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 1:218 HIDDEN PINES DR
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32408-7454
Mailing Address - Country:US
Mailing Address - Phone:859-766-1721
Mailing Address - Fax:
Practice Address - Street 1:218 HIDDEN PINES DR
Practice Address - Street 2:
Practice Address - City:PANAMA CITY BEACH
Practice Address - State:FL
Practice Address - Zip Code:32408-7454
Practice Address - Country:US
Practice Address - Phone:859-766-1721
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-18
Last Update Date:2022-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11013452363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty