Provider Demographics
NPI:1669132445
Name:PAIGE, LAURA (APRN-C)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:PAIGE
Suffix:
Gender:F
Credentials:APRN-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 120423
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34712-0423
Mailing Address - Country:US
Mailing Address - Phone:386-871-3367
Mailing Address - Fax:
Practice Address - Street 1:DELETE
Practice Address - Street 2:DELETE
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-9018
Practice Address - Country:US
Practice Address - Phone:000-000-0000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-21
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11017092363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care