Provider Demographics
NPI:1831526102
Name:SCHWEPPE, LAURIE ANN (ARNP)
Entity type:Individual
Prefix:
First Name:LAURIE
Middle Name:ANN
Last Name:SCHWEPPE
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 1:1005 MAR WALT DRIVE
Mailing Address - Street 2:
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32547-6707
Mailing Address - Country:US
Mailing Address - Phone:850-863-8202
Mailing Address - Fax:850-863-8548
Practice Address - Street 1:1005 MAR WALT DRIVVE
Practice Address - Street 2:SNF HOSPITALIST DEPARTMENT
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32547
Practice Address - Country:US
Practice Address - Phone:850-863-8100
Practice Address - Fax:850-863-8548
Is Sole Proprietor?:No
Enumeration Date:2013-10-02
Last Update Date:2019-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9262615363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLHQ862ZOtherMEDICARE PTAN