Provider Demographics
NPI:1356971329
Name:MUNZENMAIER, LAURA SIMS (APRN)
Entity type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:SIMS
Last Name:MUNZENMAIER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MISS
Other - First Name:LAURA
Other - Middle Name:SIMS
Other - Last Name:HERNANDEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10241 W BROWARD BLVD
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-2114
Mailing Address - Country:US
Mailing Address - Phone:954-236-0769
Mailing Address - Fax:
Practice Address - Street 1:12280 LAKE UNDERHILL RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32825-5009
Practice Address - Country:US
Practice Address - Phone:866-389-2727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-18
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3017725363LF0000X
FL11004719363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily