Healthcare Provider Details

I. General information

NPI: 1003541665
Provider Name (Legal Business Name): LAURA TAPIA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2022
Last Update Date: 09/06/2022
Certification Date: 09/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5425 GOLDEN GATE PKWY STE 7
NAPLES FL
34116-7524
US

IV. Provider business mailing address

3745 42ND AVE SE
NAPLES FL
34117-9476
US

V. Phone/Fax

Practice location:
  • Phone: 239-778-8455
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: