Provider Demographics
NPI:1053718395
Name:DIMAGGIO, LAUREL ELIZABETH (AGNP)
Entity type:Individual
Prefix:
First Name:LAUREL
Middle Name:ELIZABETH
Last Name:DIMAGGIO
Suffix:
Gender:F
Credentials:AGNP
Other - Prefix:
Other - First Name:LAUREL
Other - Middle Name:ELIZABETH
Other - Last Name:NORRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:601 7TH ST S STE 205
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33701-4748
Mailing Address - Country:US
Mailing Address - Phone:727-893-6234
Mailing Address - Fax:727-553-7798
Practice Address - Street 1:601 7TH ST S STE 205
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701-4748
Practice Address - Country:US
Practice Address - Phone:727-893-6234
Practice Address - Fax:727-553-7798
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-02
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9310459363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health