Provider Demographics
NPI:1699234526
Name:PRINS, LAURA MIRANDA (DO)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:MIRANDA
Last Name:PRINS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13220 STARKEY RD STE 500
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33773-1446
Mailing Address - Country:US
Mailing Address - Phone:727-398-7701
Mailing Address - Fax:727-287-4541
Practice Address - Street 1:13220 STARKEY RD STE 500
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33773-1446
Practice Address - Country:US
Practice Address - Phone:727-398-7701
Practice Address - Fax:727-287-4541
Is Sole Proprietor?:No
Enumeration Date:2019-03-19
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS18283207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine