Provider Demographics
NPI:1538353487
Name:BEATTIE, LAURA ELAINE (DOM, AP)
Entity type:Individual
Prefix:MS
First Name:LAURA
Middle Name:ELAINE
Last Name:BEATTIE
Suffix:
Gender:F
Credentials:DOM, AP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1033 S PINE RIDGE CIR
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32773-4825
Mailing Address - Country:US
Mailing Address - Phone:407-617-3990
Mailing Address - Fax:
Practice Address - Street 1:3240 W LAKE MARY BLVD
Practice Address - Street 2:STE. 1300
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-3583
Practice Address - Country:US
Practice Address - Phone:407-302-5161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-04
Last Update Date:2007-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP2438171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist