Provider Demographics
NPI:1760603252
Name:SCOTT, LAURIE ANNE (NP)
Entity type:Individual
Prefix:MRS
First Name:LAURIE
Middle Name:ANNE
Last Name:SCOTT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1671 N CLYDE MORRIS BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32117-5590
Mailing Address - Country:US
Mailing Address - Phone:386-274-2977
Mailing Address - Fax:386-317-5164
Practice Address - Street 1:1671 N CLYDE MORRIS BLVD STE 100
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32117-5590
Practice Address - Country:US
Practice Address - Phone:386-274-2977
Practice Address - Fax:386-317-5164
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP3337363L00000X
AZRN157181363LF0000X
FLAPRN11011471363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL122587600Medicaid