Provider Demographics
NPI:1790722957
Name:CICCARELLO, LAUREL E (ARNP)
Entity type:Individual
Prefix:MS
First Name:LAUREL
Middle Name:E
Last Name:CICCARELLO
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7619 ULIVA WAY
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34238-4797
Mailing Address - Country:US
Mailing Address - Phone:813-924-4787
Mailing Address - Fax:
Practice Address - Street 1:237 PAYNE PKWY UNIT 101
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34237-7018
Practice Address - Country:US
Practice Address - Phone:941-893-2556
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2025-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1426672363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE5903ZMedicare PIN
FLE5903ZMedicare ID - Type Unspecified