Provider Demographics
NPI:1144043043
Name:JARAMILLO, LAURA ANTONIA (PA)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:ANTONIA
Last Name:JARAMILLO
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5310 CLARK RD STE 106
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34233-3228
Mailing Address - Country:US
Mailing Address - Phone:941-921-0400
Mailing Address - Fax:941-870-1628
Practice Address - Street 1:5310 CLARK RD STE 106
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34233-3228
Practice Address - Country:US
Practice Address - Phone:941-921-0400
Practice Address - Fax:941-870-1628
Is Sole Proprietor?:No
Enumeration Date:2024-11-07
Last Update Date:2024-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9119503363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant