Healthcare Provider Details

I. General information

NPI: 1497554208
Provider Name (Legal Business Name): LAURA NIEBLES SA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/12/2025
Last Update Date: 03/12/2025
Certification Date: 03/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2176 SALERNO CIR
WESTON FL
33327-1920
US

IV. Provider business mailing address

2176 SALERNO CIR
WESTON FL
33327-1920
US

V. Phone/Fax

Practice location:
  • Phone: 954-614-8007
  • Fax:
Mailing address:
  • Phone: 954-614-8007
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number24-492
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: