Provider Demographics
NPI:1699706010
Name:CUNNINGHAM LAUBE, MARY J (ARNP)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:J
Last Name:CUNNINGHAM LAUBE
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:J
Other - Last Name:CUNNINGHAM HOMMINGA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:38135 MARKET SQ
Mailing Address - Street 2:
Mailing Address - City:ZEPHYRHILLS
Mailing Address - State:FL
Mailing Address - Zip Code:33542-7505
Mailing Address - Country:US
Mailing Address - Phone:813-715-0374
Mailing Address - Fax:133-555-0908
Practice Address - Street 1:550 E DIXIE AVE
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748-5925
Practice Address - Country:US
Practice Address - Phone:352-323-2273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2157532363L00000X
FLAPRN2157532363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL303842400Medicaid
FLY0158OtherBLUE CROSS BLUE SHIELD
FLY0158VMedicare ID - Type Unspecified
FL303842400Medicaid