Provider Demographics
NPI:1013306513
Name:SIRAK, LAURA ANNE (APRN)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:ANNE
Last Name:SIRAK
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:720 BROOKER CREEK BLVD STE 215
Mailing Address - Street 2:
Mailing Address - City:OLDSMAR
Mailing Address - State:FL
Mailing Address - Zip Code:34677-2937
Mailing Address - Country:US
Mailing Address - Phone:813-854-2003
Mailing Address - Fax:813-436-5378
Practice Address - Street 1:5259 VILLAGE MARKET
Practice Address - Street 2:
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33544-8401
Practice Address - Country:US
Practice Address - Phone:813-973-0333
Practice Address - Fax:813-973-2313
Is Sole Proprietor?:No
Enumeration Date:2015-01-21
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLAPRN9295963363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL14411000Medicaid