MEDICARE: MS. LAURA ANN GULICK 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
1	363L00000X	Nurse Practitioner	ARNP9337291	FL
2	363LF0000X	Family Nurse Practitioner	APRN9337291	FL
3	363L00000X	Nurse Practitioner	APRN9337291	FL

General Provider Information

NPI Number	:	1831639657
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LAURA ANN GULICK APRN

Provider Business Mailing Address
First Line	:	5210 WEBB RD
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33615-4518
Country	:	US
Telephone Number	:	813-882-9986
Fax Number	:	813-341-3259

Provider Business Practice Location Address
First Line	:	6331 MEMORIAL HWY STE D
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33615-4537
Country	:	US
Telephone Number	:	813-882-9986
Fax Number	:	813-882-9849

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

Provider Enumeration Date	:	02/27/2017
Last Update Date	:	02/22/2023

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