Healthcare Provider Details

I. General information

NPI: 1578542502
Provider Name (Legal Business Name): MELISSA ANN LAUGHREY CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2006
Last Update Date: 06/18/2020
Certification Date: 06/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1285 CREEKSIDE BLVD E UNIT 104
NAPLES FL
34109-0595
US

IV. Provider business mailing address

PO BOX 8569
NAPLES FL
34101-8569
US

V. Phone/Fax

Practice location:
  • Phone: 239-624-0630
  • Fax: 239-624-0631
Mailing address:
  • Phone: 239-624-0400
  • Fax: 239-624-0464

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAPRN11000241
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: