MEDICARE: LAURA MARIE TRIOLA ARNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	ARNP 2192422	FL
2	363L00000X	Nurse Practitioner	ARNP2192422	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	363L00000X	OTHER		TAXONOMY

General Provider Information

NPI Number	:	1073670279
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA MARIE TRIOLA ARNP

Provider Business Mailing Address
First Line	:	PO BOX 440055
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32222-0001
Country	:	US
Telephone Number	:	904-282-6331
Fax Number	:	904-619-1080

Provider Business Practice Location Address
First Line	:	1909 BEACH BLVD STE 102
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32250-2643
Country	:	US
Telephone Number	:	904-246-2752
Fax Number	:	904-246-2758

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/03/2007
Last Update Date	:	07/21/2022

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