Provider Demographics
NPI:1518701531
Name:MONTGOMERY, LAURA JOY (APRN)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:JOY
Last Name:MONTGOMERY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2963 GULF TO BAY BLVD STE 250
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33759-4255
Mailing Address - Country:US
Mailing Address - Phone:855-940-4867
Mailing Address - Fax:
Practice Address - Street 1:2963 GULF TO BAY BLVD STE 250
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33759-4255
Practice Address - Country:US
Practice Address - Phone:855-940-4867
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-24
Last Update Date:2025-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11032209363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health