Provider Demographics
NPI:1013311901
Name:WIEBER, LAURA (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:
Last Name:WIEBER
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:MS
Other - First Name:LAURA
Other - Middle Name:
Other - Last Name:BAKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:PO BOX 102222
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30368-2222
Mailing Address - Country:US
Mailing Address - Phone:239-274-8200
Mailing Address - Fax:
Practice Address - Street 1:106 BOSTON AVE STE 105
Practice Address - Street 2:
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32701-4711
Practice Address - Country:US
Practice Address - Phone:407-553-7710
Practice Address - Fax:866-445-1446
Is Sole Proprietor?:No
Enumeration Date:2014-10-21
Last Update Date:2022-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9310917363L00000X
FLARNP 9310917363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL013911700Medicaid