Individual
JOEL LAURENCEAU
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2561 SW GROTTO CIR, PORT SAINT LUCIE, FL 34953-2927
(786) 333-7288
Mailing address
2561 SW GROTTO CIR, PORT SAINT LUCIE, FL 34953-2927
(786) 333-7288
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
L652-425-70-173-0
DRIVER LICENSE
FL
Enumeration date
10/16/2020
Last updated
10/16/2020
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