MEDICARE: LAURA DAVIS WALLS APRN, FNP-BC, NP-C

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	APRN11007764	FL
2	163W00000X	Registered Nurse	RN9288809	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	:	1972125482
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA DAVIS WALLS APRN, FNP-BC, NP-C

Provider Business Mailing Address
First Line	:	601 S HARBOUR ISLAND BLVD STE 200
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33602-5925
Country	:	US
Telephone Number	:	727-322-3439
Fax Number	:	800-928-7449

Provider Business Practice Location Address
First Line	:	1755 6TH ST NW STE 2B
Second Line	:
City	:	WINTER HAVEN
State	:	FL
Zip	:	33881-2301
Country	:	US
Telephone Number	:	863-323-9813
Fax Number	:

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

Provider Enumeration Date	:	05/07/2020
Last Update Date	:	08/21/2025

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