Provider Demographics
NPI:1740538263
Name:HAGEDORN, LAURA GRIGGS (ARNP)
Entity type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:GRIGGS
Last Name:HAGEDORN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9679 LAKE NONA VILLAGE PL STE 101
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32827-7310
Mailing Address - Country:US
Mailing Address - Phone:407-261-2934
Mailing Address - Fax:407-363-7811
Practice Address - Street 1:9679 LAKE NONA VILLAGE PL STE 101
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32827-7310
Practice Address - Country:US
Practice Address - Phone:407-261-2934
Practice Address - Fax:407-363-7811
Is Sole Proprietor?:No
Enumeration Date:2012-08-15
Last Update Date:2020-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP3113192363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily