Provider Demographics
NPI:1639702749
Name:ANDERSON, LAURA
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4160 FRUITVILLE RD UNIT 25
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34232-1659
Mailing Address - Country:US
Mailing Address - Phone:941-685-4225
Mailing Address - Fax:
Practice Address - Street 1:4160 FRUITVILLE RD UNIT 25
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34232-1659
Practice Address - Country:US
Practice Address - Phone:941-685-4225
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-17
Last Update Date:2020-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9368720163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse