Healthcare Provider Details

I. General information

NPI: 1831742279
Provider Name (Legal Business Name): LAURA GONZALEZ LICOURT APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2019
Last Update Date: 03/19/2026
Certification Date: 03/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6836 MEDICAL VIEW LN
ZEPHYRHILLS FL
33542-6615
US

IV. Provider business mailing address

2600 S DOUGLAS RD STE 308
CORAL GABLES FL
33134-6134
US

V. Phone/Fax

Practice location:
  • Phone: 813-859-5449
  • Fax: 813-395-5478
Mailing address:
  • Phone: 786-409-9226
  • Fax: 813-279-8086

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11002952
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: