Provider Demographics
NPI:1356064661
Name:EATON-JANKOV, LAURA LEE (APRN)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:LEE
Last Name:EATON-JANKOV
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 1:2307 SEA ISLAND DR
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33301-1574
Mailing Address - Country:US
Mailing Address - Phone:949-468-9301
Mailing Address - Fax:
Practice Address - Street 1:4420 N.E. 20TH AVE, SUITE J
Practice Address - Street 2:
Practice Address - City:OAKLAND PARK
Practice Address - State:FL
Practice Address - Zip Code:33308
Practice Address - Country:US
Practice Address - Phone:954-288-2625
Practice Address - Fax:954-206-7834
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-21
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11021972363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily