Healthcare Provider Details

I. General information

NPI: 1508383407
Provider Name (Legal Business Name): LAURA BELLE MAUPIN ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/23/2017
Last Update Date: 09/04/2020
Certification Date: 09/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4453 HIGHWAY 90
PACE FL
32571-2066
US

IV. Provider business mailing address

4453 HIGHWAY 90
PACE FL
32571-2066
US

V. Phone/Fax

Practice location:
  • Phone: 850-905-0110
  • Fax:
Mailing address:
  • Phone: 850-905-0110
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number80673
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3235012
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: