Provider Demographics
NPI:1790938322
Name:MORETTE, LAURA RAE DEMETER (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:LAURA RAE
Middle Name:DEMETER
Last Name:MORETTE
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 1:4860 WOODBINE RD
Mailing Address - Street 2:SUITE 1 & 2
Mailing Address - City:PACE
Mailing Address - State:FL
Mailing Address - Zip Code:32571-8709
Mailing Address - Country:US
Mailing Address - Phone:850-995-8087
Mailing Address - Fax:850-994-5292
Practice Address - Street 1:4860 WOODBINE RD
Practice Address - Street 2:SUITE 1 & 2
Practice Address - City:PACE
Practice Address - State:FL
Practice Address - Zip Code:32571-8709
Practice Address - Country:US
Practice Address - Phone:850-995-8087
Practice Address - Fax:850-994-5292
Is Sole Proprietor?:No
Enumeration Date:2008-10-28
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 9203869363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLARNP 9203869OtherADVANCED REGISTERED NURSE PRACTITIONER