Provider Demographics
NPI:1538599766
Name:MAZZA, LAURA (ANP-BC)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:MAZZA
Suffix:
Gender:F
Credentials:ANP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 SYCAMORE AVE
Mailing Address - Street 2:
Mailing Address - City:LITTLE SILVER
Mailing Address - State:NJ
Mailing Address - Zip Code:07739-1208
Mailing Address - Country:US
Mailing Address - Phone:732-576-8610
Mailing Address - Fax:732-576-8823
Practice Address - Street 1:39 SYCAMORE AVE
Practice Address - Street 2:
Practice Address - City:LITTLE SILVER
Practice Address - State:NJ
Practice Address - Zip Code:07739-1208
Practice Address - Country:US
Practice Address - Phone:732-576-8610
Practice Address - Fax:732-576-8823
Is Sole Proprietor?:No
Enumeration Date:2013-11-25
Last Update Date:2013-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00476700363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health