Provider Demographics
NPI:1841523172
Name:TOBANI, LAURETTA (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:LAURETTA
Middle Name:
Last Name:TOBANI
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 LAUREL RD
Mailing Address - Street 2:
Mailing Address - City:EAST NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11731-1415
Mailing Address - Country:US
Mailing Address - Phone:631-930-9399
Mailing Address - Fax:631-261-5424
Practice Address - Street 1:101 LAUREL RD
Practice Address - Street 2:
Practice Address - City:EAST NORTHPORT
Practice Address - State:NY
Practice Address - Zip Code:11731-1415
Practice Address - Country:US
Practice Address - Phone:631-930-9399
Practice Address - Fax:631-261-5424
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-18
Last Update Date:2009-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF331658-1363LF0000X
NYF420367-1363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health