Provider Demographics
NPI:1770640807
Name:MOFFATT, LAURA L (ARNP, LMT,CCRN, CPAN)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:L
Last Name:MOFFATT
Suffix:
Gender:F
Credentials:ARNP, LMT,CCRN, CPAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2520 NE 7TH ST
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34470-6315
Mailing Address - Country:US
Mailing Address - Phone:352-369-9960
Mailing Address - Fax:
Practice Address - Street 1:2520 NE 7TH ST
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34470-6315
Practice Address - Country:US
Practice Address - Phone:352-369-9960
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-01
Last Update Date:2013-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA33334225700000X
FLARNP1472172363LC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LC0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCritical Care Medicine
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist