Provider Demographics
NPI:1023623204
Name:STAPLES, LAURONDA (LPN)
Entity type:Individual
Prefix:
First Name:LAURONDA
Middle Name:
Last Name:STAPLES
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1405 MINNESOTA AVE # 2
Mailing Address - Street 2:
Mailing Address - City:LYNN HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:32444-3853
Mailing Address - Country:US
Mailing Address - Phone:404-453-4286
Mailing Address - Fax:
Practice Address - Street 1:1405 MINNESOTA AVE # 2
Practice Address - Street 2:
Practice Address - City:LYNN HAVEN
Practice Address - State:FL
Practice Address - Zip Code:32444-3853
Practice Address - Country:US
Practice Address - Phone:404-453-4286
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-14
Last Update Date:2020-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPN5240203251E00000X
251G00000X, 253Z00000X, 261QM1300X, 261QR0800X, 343900000X, 385H00000X, 385HR2055X, 385HR2060X, 385HR2065X, 251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
No251E00000XAgenciesHome Health
No251G00000XAgenciesHospice Care, Community Based
No253Z00000XAgenciesIn Home Supportive Care
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261QR0800XAmbulatory Health Care FacilitiesClinic/CenterRecovery Care
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No385H00000XRespite Care FacilityRespite Care
No385HR2055XRespite Care FacilityRespite CareRespite Care, Mental Illness, Child
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child
No385HR2065XRespite Care FacilityRespite CareRespite Care, Physical Disabilities, Child