MEDICARE: LAURA GONZALEZ LICOURT APRN

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	11002952	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1831742279
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA GONZALEZ LICOURT APRN

Provider Business Mailing Address
First Line	:	2600 S DOUGLAS RD STE 308
Second Line	:
City	:	CORAL GABLES
State	:	FL
Zip	:	33134-6134
Country	:	US
Telephone Number	:	786-409-9226
Fax Number	:	813-279-8086

Provider Business Practice Location Address
First Line	:	6836 MEDICAL VIEW LN
Second Line	:
City	:	ZEPHYRHILLS
State	:	FL
Zip	:	33542-6615
Country	:	US
Telephone Number	:	813-859-5449
Fax Number	:	813-395-5478

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

Provider Enumeration Date	:	07/23/2019
Last Update Date	:	03/19/2026

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