Healthcare Provider Details

I. General information

NPI: 1568630408
Provider Name (Legal Business Name): LAURA HANKE ARNP LTD CO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2008
Last Update Date: 03/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3805 PROMENADE WAY
FORT PIERCE FL
34982-6568
US

IV. Provider business mailing address

3805 PROMENADE WAY
FORT PIERCE FL
34982-6568
US

V. Phone/Fax

Practice location:
  • Phone: 772-794-1291
  • Fax: 772-794-4435
Mailing address:
  • Phone: 772-794-1291
  • Fax: 772-794-4435

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number2831342
License Number StateFL

VIII. Authorized Official

Name: LAURA HANKE
Title or Position: PRESIDENT/OWNER
Credential: ARNP
Phone: 772-794-1291