Provider Demographics
NPI:1376133397
Name:HOLTZCLAW, LAURIE ANN (APRN)
Entity type:Individual
Prefix:
First Name:LAURIE
Middle Name:ANN
Last Name:HOLTZCLAW
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 1:10265 SW 23RD CT
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33324-7619
Mailing Address - Country:US
Mailing Address - Phone:954-643-4252
Mailing Address - Fax:
Practice Address - Street 1:10265 SW 23RD CT
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33324-7619
Practice Address - Country:US
Practice Address - Phone:954-643-4252
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-23
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9508781163W00000X
FL11033869363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse