Healthcare Provider Details

I. General information

NPI: 1740538263
Provider Name (Legal Business Name): LAURA GRIGGS HAGEDORN ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2012
Last Update Date: 05/22/2020
Certification Date: 05/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9679 LAKE NONA VILLAGE PL STE 101
ORLANDO FL
32827-7310
US

IV. Provider business mailing address

9679 LAKE NONA VILLAGE PL STE 101
ORLANDO FL
32827-7310
US

V. Phone/Fax

Practice location:
  • Phone: 407-261-2934
  • Fax: 407-363-7811
Mailing address:
  • Phone: 407-261-2934
  • Fax: 407-363-7811

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP3113192
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: