Healthcare Provider Details

I. General information

NPI: 1366456451
Provider Name (Legal Business Name): LAURA RIZZO BRACEY ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2202 STATE AVE STE 2202
PANAMA CITY FL
32405-7601
US

IV. Provider business mailing address

2202 STATE AVE STE 301
PANAMA CITY FL
32405-4590
US

V. Phone/Fax

Practice location:
  • Phone: 850-215-7071
  • Fax:
Mailing address:
  • Phone: 850-215-7071
  • Fax: 850-215-7073

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11047913
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: