MEDICARE: MYCOSE LAURENT

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	APRN11048272	FL

General Provider Information

NPI Number	:	1124953096
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MYCOSE LAURENT

Provider Business Mailing Address
First Line	:	4979 GOLDEN ZENITH WAY
Second Line	:
City	:	MOUNT DORA
State	:	FL
Zip	:	32757-7723
Country	:	US
Telephone Number	:	954-479-0814
Fax Number	:

Provider Business Practice Location Address
First Line	:	4979 GOLDEN ZENITH WAY
Second Line	:
City	:	MOUNT DORA
State	:	FL
Zip	:	32757-7723
Country	:	US
Telephone Number	:	954-479-0814
Fax Number	:

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

Provider Enumeration Date	:	06/15/2026
Last Update Date	:	06/15/2026

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Directions to “ MYCOSE LAURENT ” Practice Location

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