Provider Demographics
NPI:1407398639
Name:JUAREZ, LAURA ELISE (PA-C)
Entity type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:ELISE
Last Name:JUAREZ
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 615
Mailing Address - Street 2:
Mailing Address - City:DORADO
Mailing Address - State:PR
Mailing Address - Zip Code:00646-0615
Mailing Address - Country:US
Mailing Address - Phone:801-362-6791
Mailing Address - Fax:
Practice Address - Street 1:1265 S UTICA AVE STE 105
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74104-4243
Practice Address - Country:US
Practice Address - Phone:918-592-0999
Practice Address - Fax:918-592-1021
Is Sole Proprietor?:No
Enumeration Date:2016-11-04
Last Update Date:2025-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR000919208600000X
UT363AM0700X
OK4749363AS0400X
CA56826363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No208600000XAllopathic & Osteopathic PhysiciansSurgery
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical