Provider Demographics
NPI:1508604216
Name:MCCORMICK, LAURA D (APRN)
Entity type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:D
Last Name:MCCORMICK
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MS
Other - First Name:LAURA
Other - Middle Name:D
Other - Last Name:MCCORMICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1100 AVALON CT
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32305-8836
Mailing Address - Country:US
Mailing Address - Phone:850-445-1344
Mailing Address - Fax:
Practice Address - Street 1:1100 AVALON CT
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32305-8836
Practice Address - Country:US
Practice Address - Phone:850-445-1344
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-17
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11033882363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily