MEDICARE: LAURA NUGENT LMT

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
1	1041C0700X	Clinical Social Worker	SW11421	FL
2	225700000X	Massage Therapist	MA41764	FL

General Provider Information

NPI Number	:	1801053392
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA NUGENT LMT

Provider Business Mailing Address
First Line	:	326 ELLIS ROAD
Second Line	:	UNIT 107
City	:	MIRAMAR BEACH
State	:	FL
Zip	:	32550
Country	:	US
Telephone Number	:	850-543-8929
Fax Number	:

Provider Business Practice Location Address
First Line	:	326 ELLIS RD UNIT 107
Second Line	:
City	:	MIRAMAR BEACH
State	:	FL
Zip	:	32550-6855
Country	:	US
Telephone Number	:	850-543-8929
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/21/2008
Last Update Date	:	02/02/2019

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