Provider Demographics
NPI:1134339187
Name:COHEN, LAURA A (CRNA)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:A
Last Name:COHEN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5983 ARCH AVE
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32526-3232
Mailing Address - Country:US
Mailing Address - Phone:850-607-9264
Mailing Address - Fax:
Practice Address - Street 1:5983 ARCH AVE
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32526-3232
Practice Address - Country:US
Practice Address - Phone:850-607-9264
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2010-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN024038 AP01749367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS01039348Medicaid
FL308478700Medicaid
LA1018830Medicaid
FLAE315Medicare PIN
LA1018830Medicaid
LA599877061Medicare PIN