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General NPI Number Information
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NPI Number | 1538560925
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Entity Type | Individual
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Provider Name | RENEE SAMUELS LAURENT APRN, PMHNP-BC
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Gender | Female
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Dates
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Enumeration Date | 09/04/2014
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Last Update Date | 12/02/2025
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Provider Practice Location Address
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Address Line | 2055 REYKO RD STE 100
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City | JACKSONVILLE
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State | FL
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Zip | 32207-2828
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Country | US
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Telephone | 239-690-6906
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Fax |
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Provider Business Mailing Address
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Address Line | 2055 REYKO RD STE 100
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City | JACKSONVILLE
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State | FL
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Zip | 32207-2828
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Country | US
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Telephone | 239-690-6906
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 6892141
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | APRN11024745
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License Number State | FL
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