Healthcare Provider Details

I. General information

NPI: 1982135687
Provider Name (Legal Business Name): LAURA J PELLEGRINI APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2017
Last Update Date: 11/27/2023
Certification Date: 09/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1755 N FLORIDA AVE
LAKELAND FL
33805-3109
US

IV. Provider business mailing address

1600 LAKELAND HILLS BLVD.
LAKELAND FL
33805-3065
US

V. Phone/Fax

Practice location:
  • Phone: 863-680-7243
  • Fax: 866-264-8519
Mailing address:
  • Phone: 863-680-7000
  • Fax: 866-264-8519

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP2893322
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberARNP2893322
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN2893322
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: