Provider Demographics
NPI:1215220348
Name:STEFANIC, LAURA MARIE (DNP, ARNP)
Entity type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:MARIE
Last Name:STEFANIC
Suffix:
Gender:F
Credentials:DNP, ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 DAWSON COMMONS CIR
Mailing Address - Street 2:
Mailing Address - City:DAWSONVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30534-6268
Mailing Address - Country:US
Mailing Address - Phone:706-216-2771
Mailing Address - Fax:
Practice Address - Street 1:300 DAWSON COMMONS CIR STE 320
Practice Address - Street 2:
Practice Address - City:DAWSONVILLE
Practice Address - State:GA
Practice Address - Zip Code:30534-6268
Practice Address - Country:US
Practice Address - Phone:216-706-2771
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-23
Last Update Date:2025-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9320010363LP0200X
GA336366363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY08FGOtherBLUE CROSS BLUE SHIELD
FL003555500Medicaid
FLY08FGOtherBLUE CROSS BLUE SHIELD