Individual
LAURA NYWENING
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2 TAMPA GENERAL CIR, TAMPA, FL 33606-3571
(813) 974-2201
(813) 974-2201
Mailing address
PO BOX 917770, ORLANDO, FL 32891-0001
(813) 974-2201
(813) 974-4325
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
2016016498
MO
207V00000X
Obstetrics & Gynecology Physician
Primary
ME148744
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
111023800
—
FL
01
—
64FVN
BLUE CROSS BLUE SHIELD
FL
Enumeration date
06/15/2012
Last updated
08/12/2021
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