Doctor Name: | LAURA WHITE |
NPI Number: | 1083626436 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PA |
License Number: | PA9103032 |
Business Practice Address: | 525 E Olympia Ave Punta Gorda, FL - 339503861 |
Business Phone Number: | 9416377000 |
Business Fax Number: | 9416397576 |
Mailing Address: | 4130 Tamiami Trl, PORT CHARLOTTE |
State: | FL |
Postal Code: | 339529207 |
Phone Number: | 9416377000 |
Fax Number: | 9416397576 |
NPI Enumeration Date: | 08/13/2006 |
NPI Last Update Date: | 11/01/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AM0700X |
License Number: | PA9103032 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Medical |
Taxonomy Definition: |