Provider Demographics
NPI:1760882948
Name:ANTINARELLA, LAURA (NP)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:ANTINARELLA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:
Other - Last Name:CIPRO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:138 HIGH DUNE LOOP
Mailing Address - Street 2:
Mailing Address - City:KITTY HAWK
Mailing Address - State:NC
Mailing Address - Zip Code:27949-3707
Mailing Address - Country:US
Mailing Address - Phone:252-581-1912
Mailing Address - Fax:252-408-4318
Practice Address - Street 1:3118 N CROATAN HWY STE 206
Practice Address - Street 2:
Practice Address - City:KILL DEVIL HILLS
Practice Address - State:NC
Practice Address - Zip Code:27948-9252
Practice Address - Country:US
Practice Address - Phone:252-581-1912
Practice Address - Fax:252-408-4318
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-25
Last Update Date:2025-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6697363LP0808X
UT9106742-4405363LP0808X
NC5019698363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health