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NPI Code Detail

MEDICARE: MRS. LAURA T LOGAN APRN

MEDICARE: MRS. LAURA T LOGAN APRN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363L00000XNurse PractitionerAPRN9162621FL
2363LF0000XFamily Nurse PractitionerAPRN9162621FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1497098586
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. LAURA T LOGAN APRN
Provider Business Mailing Address
First Line : PO BOX 746638
Second Line :
City : ATLANTA
State : GA
Zip : 30374-6638
Country : US
Telephone Number : 904-202-1032
Fax Number : 904-376-4107
Provider Business Practice Location Address
First Line : 400 COLONNADE DR STE 160
Second Line :
City : PONTE VEDRA
State : FL
Zip : 32081-6236
Country : US
Telephone Number : 904-824-1020
Fax Number : 904-390-7503
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/27/2013
Last Update Date : 01/30/2023

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Directions to “ MRS. LAURA T LOGAN APRN” Practice Location

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