Provider Demographics
NPI:1629005244
Name:DICARLO, LAURETTE M (ARNP)
Entity Type:Individual
Prefix:
First Name:LAURETTE
Middle Name:M
Last Name:DICARLO
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 1:11349 110TH TERR N
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33778-3708
Mailing Address - Country:US
Mailing Address - Phone:727-393-9821
Mailing Address - Fax:727-393-9821
Practice Address - Street 1:6399 38TH AVE N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33710-1647
Practice Address - Country:US
Practice Address - Phone:727-384-6411
Practice Address - Fax:727-384-9033
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 1364582363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY7107 ZMedicare ID - Type Unspecified
FLS68174Medicare UPIN