Provider Demographics
NPI:1356056717
Name:PRIFOGLE, LAURA ASHLEY (FNP-C)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:ASHLEY
Last Name:PRIFOGLE
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5157 SHELLBARK CT
Mailing Address - Street 2:
Mailing Address - City:GROVEPORT
Mailing Address - State:OH
Mailing Address - Zip Code:43125-9399
Mailing Address - Country:US
Mailing Address - Phone:614-456-9368
Mailing Address - Fax:
Practice Address - Street 1:5157 SHELLBARK CT
Practice Address - Street 2:
Practice Address - City:GROVEPORT
Practice Address - State:OH
Practice Address - Zip Code:43125-9399
Practice Address - Country:US
Practice Address - Phone:614-456-9368
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-19
Last Update Date:2023-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11021756363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily