Provider Demographics
NPI:1306308770
Name:NALL, LAURA CATHERINE (MD)
Entity type:Individual
Prefix:DR
First Name:LAURA
Middle Name:CATHERINE
Last Name:NALL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:CATE
Other - Middle Name:
Other - Last Name:NALL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:2675 WINKLER AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901-9342
Mailing Address - Country:US
Mailing Address - Phone:778-563-7748
Mailing Address - Fax:239-599-2612
Practice Address - Street 1:1907 S ALEXANDER ST STE 1
Practice Address - Street 2:
Practice Address - City:PLANT CITY
Practice Address - State:FL
Practice Address - Zip Code:33566-0921
Practice Address - Country:US
Practice Address - Phone:813-754-3344
Practice Address - Fax:813-754-3574
Is Sole Proprietor?:No
Enumeration Date:2019-04-03
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME147347207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine