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NPI Code Detail

MEDICARE: LAURA ANNE BACON APRN, FNP

MEDICARE: LAURA ANNE BACON APRN, FNP
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
1363LF0000XFamily Nurse PractitionerARNP9307946FL

General Provider Information

NPI Number : 1760932651
Entity Type Code : Individual
Provider Name (Legal Business Name) : LAURA ANNE BACON APRN, FNP
Provider Business Mailing Address
First Line : 8100 N DAVIS HWY
Second Line :
City : PENSACOLA
State : FL
Zip : 32514-6093
Country : US
Telephone Number : 866-389-2727
Fax Number :
Provider Business Practice Location Address
First Line : 8100 N DAVIS HWY
Second Line :
City : PENSACOLA
State : FL
Zip : 32514-6093
Country : US
Telephone Number : 866-389-2727
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/04/2016
Last Update Date : 09/19/2019

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