Provider Demographics
NPI:1972524536
Name:FLECK, LAUREEN MARIE (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:LAUREEN
Middle Name:MARIE
Last Name:FLECK
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 1:21401 GOSIER WAY
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33428-4840
Mailing Address - Country:US
Mailing Address - Phone:561-483-4424
Mailing Address - Fax:
Practice Address - Street 1:5458 TOWN CENTER RD
Practice Address - Street 2:SUITE 21
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33486-1089
Practice Address - Country:US
Practice Address - Phone:561-750-7300
Practice Address - Fax:561-750-8918
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2757142363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP35587Medicare UPIN
FLY9310YMedicare PIN
FLY9310ZMedicare ID - Type Unspecified