=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316954902
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NANCY LAUREANO PA-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/03/2006
-----------------------------------------------------
Last Update Date | 02/28/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1400 27TH ST
-----------------------------------------------------
City | VERO BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32960-0303
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 772-257-8224
-----------------------------------------------------
Fax | 772-252-3245
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1555 INDIAN RIVER BLVD
-----------------------------------------------------
City | VERO BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32960-5639
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 772-257-8224
-----------------------------------------------------
Fax | 772-252-3245
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363AM0700X
-----------------------------------------------------
Taxonomy Name | Medical Physician Assistant
-----------------------------------------------------
License Number | PA 9103378
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------