Healthcare Provider Details

I. General information

NPI: 1538083308
Provider Name (Legal Business Name): IVEANNETTE CHEVEREZ LAUREANO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/05/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4379 GUMBO LIMBO DR
ORLANDO FL
32822-3170
US

IV. Provider business mailing address

1300 W OAK ST
KISSIMMEE FL
34741-4024
US

V. Phone/Fax

Practice location:
  • Phone: 787-672-0049
  • Fax:
Mailing address:
  • Phone: 407-303-2030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11049446
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: