Healthcare Provider Details

I. General information

NPI: 1356397962
Provider Name (Legal Business Name): LAURA ARRISON DUNTON ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4611 US HIGHWAY 17 STE 1
FLEMING ISLAND FL
32003-8248
US

IV. Provider business mailing address

4611 US HIGHWAY 17 STE 1
FLEMING ISLAND FL
32003-8248
US

V. Phone/Fax

Practice location:
  • Phone: 904-264-4333
  • Fax: 904-264-4301
Mailing address:
  • Phone: 904-264-4333
  • Fax: 904-264-4301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number9179756
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: