Provider Demographics
NPI:1427522440
Name:DEMAREST, LAURA CHANCEY
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:CHANCEY
Last Name:DEMAREST
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10261 BLOSSOM TRL
Mailing Address - Street 2:
Mailing Address - City:SEMINOLE
Mailing Address - State:FL
Mailing Address - Zip Code:33772-7423
Mailing Address - Country:US
Mailing Address - Phone:727-488-6588
Mailing Address - Fax:
Practice Address - Street 1:10261 BLOSSOM TRL
Practice Address - Street 2:
Practice Address - City:SEMINOLE
Practice Address - State:FL
Practice Address - Zip Code:33772-7423
Practice Address - Country:US
Practice Address - Phone:727-488-6588
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-12
Last Update Date:2019-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant