Provider Demographics
NPI:1790722957
Name:CICCARELLO, LAUREL E (ARNP)
Entity Type:Individual
Prefix:MS
First Name:LAUREL
Middle Name:E
Last Name:CICCARELLO
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 1:512 PINEWALK DR
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33510-2100
Mailing Address - Country:US
Mailing Address - Phone:813-651-5930
Mailing Address - Fax:
Practice Address - Street 1:717 W ROBERTSON ST
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-4921
Practice Address - Country:US
Practice Address - Phone:813-661-6339
Practice Address - Fax:813-661-6442
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1426672363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE5903ZMedicare PIN
FLE5903ZMedicare ID - Type Unspecified