Healthcare Provider Details

I. General information

NPI: 1356751291
Provider Name (Legal Business Name): LAURICE GIRGIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/30/2014
Last Update Date: 04/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1565 FERNGRAN AVE
WEST PALM BEACH FL
33415-9123
US

IV. Provider business mailing address

1565 FERNGRAN AVE
WEST PALM BEACH FL
33415-9123
US

V. Phone/Fax

Practice location:
  • Phone: 561-729-7892
  • Fax:
Mailing address:
  • Phone: 561-729-7892
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC3500X
TaxonomyCardiac Rehabilitation Registered Nurse
License NumberRN9320297
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License NumberRN9320297
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License NumberCNA171968
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: