Healthcare Provider Details

I. General information

NPI: 1437866852
Provider Name (Legal Business Name): LAURA DEL LLANO LEMUS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/04/2022
Last Update Date: 07/02/2025
Certification Date: 07/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

919 NE 13TH ST
FORT LAUDERDALE FL
33304-2009
US

IV. Provider business mailing address

8505 NW 59TH PL
TAMARAC FL
33321-4255
US

V. Phone/Fax

Practice location:
  • Phone: 954-763-2030
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number11022884
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: