Healthcare Provider Details

I. General information

NPI: 1689034456
Provider Name (Legal Business Name): LAURA RICCOBONO RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/07/2016
Last Update Date: 03/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 NW 29TH MANOR AMR TRAINING FACILITY
POMPANO BEACH FL
33069
US

IV. Provider business mailing address

9130 LEATHERWOOD LOOP
LEHIGH ACRES FL
33936-4937
US

V. Phone/Fax

Practice location:
  • Phone: 855-488-4875
  • Fax:
Mailing address:
  • Phone: 239-849-4105
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number3412892
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: