Provider Demographics
NPI:1295730059
Name:PULIDO, LAURA Y (APRN)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:Y
Last Name:PULIDO
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4520 W OAKELLAR AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33611-3114
Mailing Address - Country:US
Mailing Address - Phone:813-883-0162
Mailing Address - Fax:
Practice Address - Street 1:3005 W EUCLID AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33629-8954
Practice Address - Country:US
Practice Address - Phone:813-508-1859
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-17
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN1570142363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001386800Medicaid
FLP00865875OtherRAILROAD MEDICARE
FLY04FROtherBLUE CROSS BLUE SHIELD
FLP00865875OtherRAILROAD MEDICARE
FL001386800Medicaid