Healthcare Provider Details

I. General information

NPI: 1194006072
Provider Name (Legal Business Name): LAURA LYNN KOACH NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAURA SEALES APRN

II. Dates (important events)

Enumeration Date: 09/06/2011
Last Update Date: 09/15/2020
Certification Date: 09/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12083 CORTEZ BLVD
BROOKSVILLE FL
34613-7350
US

IV. Provider business mailing address

14690 SPRING HILL DR STE 305
SPRING HILL FL
34609-8102
US

V. Phone/Fax

Practice location:
  • Phone: 352-596-4022
  • Fax: 352-596-9851
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAPRN9483693
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: