Basic Information
| Provider Information | |||||||||
| NPI: | 1194279265 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DELAURA | ||||||||
| FirstName: | BIANCA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | ARNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13421 S SHORE BLVD STE 101 | ||||||||
| Address2: | |||||||||
| City: | WELLINGTON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334147210 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5614401616 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 13421 S SHORE BLVD STE 101 | ||||||||
| Address2: | |||||||||
| City: | WELLINGTON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334147210 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5614401616 | ||||||||
| FaxNumber: | 5614402030 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/06/2016 | ||||||||
| LastUpdateDate: | 11/20/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | ARNP 9328572 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.