Healthcare Provider Details

I. General information

NPI: 1063735983
Provider Name (Legal Business Name): LAURETTA FRANCES HUFF RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/05/2010
Last Update Date: 04/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5414 KEEL DR
PENSACOLA FL
32507-7978
US

IV. Provider business mailing address

5414 KEEL DR
PENSACOLA FL
32507-7978
US

V. Phone/Fax

Practice location:
  • Phone: 904-891-4196
  • Fax:
Mailing address:
  • Phone: 904-891-4196
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number0001141378
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: