Provider Demographics
NPI:1215108295
Name:DIRICO, LAURA A (FNP-C)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:A
Last Name:DIRICO
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:285 BLVD NE
Mailing Address - Street 2:SUITE 345
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30312
Mailing Address - Country:US
Mailing Address - Phone:404-653-0039
Mailing Address - Fax:404-653-0159
Practice Address - Street 1:285 BOULEVARD NE
Practice Address - Street 2:SUITE 345
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30312-4205
Practice Address - Country:US
Practice Address - Phone:404-653-0039
Practice Address - Fax:404-653-0159
Is Sole Proprietor?:No
Enumeration Date:2008-03-18
Last Update Date:2009-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA104267363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily