Individual
LAURIE ANN MARCIONETTE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LDO
Contact information
Practice address
13128 CORTEZ BLVD, BROOKSVILLE, FL 34613-4858
(352) 597-0410
(352) 515-0750
Mailing address
4359 35TH ST N, ST PETERSBURG, FL 33714-3717
(727) 914-8615
(727) 914-8610
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
DO2242
FL
Other
Enumeration date
07/25/2018
Last updated
07/25/2018
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