Provider Demographics
NPI:1750932695
Name:DE FELICE, LAURA GAIL
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:GAIL
Last Name:DE FELICE
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 1:636-A FAIRWAY CIRCLE
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34472
Mailing Address - Country:US
Mailing Address - Phone:352-282-2029
Mailing Address - Fax:
Practice Address - Street 1:636-A FAIRWAY CIRCLE
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34472
Practice Address - Country:US
Practice Address - Phone:352-282-2029
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-23
Last Update Date:2019-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider