Healthcare Provider Details

I. General information

NPI: 1790938322
Provider Name (Legal Business Name): LAURA RAE DEMETER MORETTE A.R.N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/28/2008
Last Update Date: 10/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4860 WOODBINE RD SUITE 1 & 2
PACE FL
32571-8709
US

IV. Provider business mailing address

4860 WOODBINE RD SUITE 1 & 2
PACE FL
32571-8709
US

V. Phone/Fax

Practice location:
  • Phone: 850-995-8087
  • Fax: 850-994-5292
Mailing address:
  • Phone: 850-995-8087
  • Fax: 850-994-5292

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberARNP 9203869
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: