Provider Demographics
NPI:1386887891
Name:LEBO, LAURA THERESA (ARNP)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:THERESA
Last Name:LEBO
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1326 SR 100
Mailing Address - Street 2:
Mailing Address - City:GRANDIN
Mailing Address - State:FL
Mailing Address - Zip Code:32138
Mailing Address - Country:US
Mailing Address - Phone:386-659-2104
Mailing Address - Fax:
Practice Address - Street 1:1326 SR 100
Practice Address - Street 2:
Practice Address - City:GRANDIN
Practice Address - State:FL
Practice Address - Zip Code:32138
Practice Address - Country:US
Practice Address - Phone:386-659-2104
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-14
Last Update Date:2009-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9264374363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily