Provider Demographics
NPI:1831484013
Name:HICE, LAURA ROSE (APRN)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:ROSE
Last Name:HICE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MS
Other - First Name:LAURA
Other - Middle Name:ROSE
Other - Last Name:CLARK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:2055 PROFESSIONAL CENTER DR
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-4461
Mailing Address - Country:US
Mailing Address - Phone:904-276-4500
Mailing Address - Fax:904-276-4160
Practice Address - Street 1:2055 PROFESSIONAL CENTER DR
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-4461
Practice Address - Country:US
Practice Address - Phone:904-276-4500
Practice Address - Fax:904-276-4160
Is Sole Proprietor?:No
Enumeration Date:2011-06-15
Last Update Date:2020-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9183747363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily