Healthcare Provider Details

I. General information

NPI: 1790722957
Provider Name (Legal Business Name): LAUREL E CICCARELLO ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2006
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

237 PAYNE PKWY UNIT 101
SARASOTA FL
34237-7018
US

IV. Provider business mailing address

7619 ULIVA WAY
SARASOTA FL
34238-4797
US

V. Phone/Fax

Practice location:
  • Phone: 941-893-2556
  • Fax:
Mailing address:
  • Phone: 813-924-4787
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1426672
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: