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General NPI Number Information
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NPI Number | 1497383194
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Entity Type | Individual
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Provider Name | LAURA LEE GIANDOMENICO ARNP
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Gender | Female
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Dates
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Enumeration Date | 03/29/2020
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Last Update Date | 03/05/2025
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Provider Practice Location Address
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Address Line | 200 SE HOSPITAL AVE
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City | STUART
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State | FL
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Zip | 34994-2346
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Country | US
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Telephone | 772-678-8634
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Fax | 772-221-2093
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Provider Business Mailing Address
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Address Line | 381 SE GREENWAY TER
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City | PORT SAINT LUCIE
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State | FL
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Zip | 34983-2638
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Country | US
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Telephone | 772-678-8634
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | APRN11005464
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License Number State | FL
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