LAURA GRACE HAVER (NPI# 1538418678) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1538418678 |
| Entity Type | Individual |
| Full Name | LAURA GRACE HAVER |
| Credential | PA-C |
| Practice Address |
8725 N Wickham Rd Ste 200 Melbourne FL 32940-2240 |
| Mailing Address |
3300 S Fiske Blvd Rockledge FL 32955-4306 |
| Practice Telephone | 3214349230 |
| Practice Fax Number | 3214349269 |
| Mailing Telephone | 3214349230 |
| Mailing Fax Number | 3219517408 |
| Enumeration Date | 2012-09-05 |
| Last Update Date | 2019-07-02 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AS0400X |
Physician Assistant Specialization: Surgical Technologist |
PA9106534 | FL | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| FL | 010403100 | 05 | |
| FL | MEDICARE | GV589Y | 01 |
| Street Address |
8725 N WICKHAM RD STE 200 |
| City | MELBOURNE |
| State | FL |
| Zip Code | 32940-2240 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700870847 | Mark Douglas Hughes | Internal Medicine | 8725 N Wickham Rd Ste 200, Melbourne, FL 32940-2240 | 2005-09-06 |
| 1902364292 | Dianne Sawers-vidal | Nurse Practitioner | 8725 N Wickham Rd Ste 200, Melbourne, FL 32940-2240 | 2019-03-06 |
| 1427409457 | Kristin E Dammann | Physician Assistant | 8725 N Wickham Rd Ste 200, Melbourne, FL 32940-2240 | 2016-06-30 |
| 1508179755 | Evelyn Frances Ogle | Physician Assistant | 8725 N Wickham Rd Ste 200, Melbourne, FL 32940-2240 | 2010-07-16 |
| 1902122781 | Kenneth K Tieu | Surgery | 8725 N Wickham Rd Ste 200, Melbourne, FL 32940-2240 | 2010-04-19 |
| 1093941205 | Xiaosong Song | Internal Medicine | 8725 N Wickham Rd Ste 200, Melbourne, FL 32940-2240 | 2009-06-02 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700403649 | True Motion Physical Therapy and Wellness | Clinic/Center | 3536 Peninsula Circle, Mlebourne, FL 32940 | 2020-06-26 |
| 1568089431 | Live Gracefully Physio and Wellness, Pllc | Clinic/Center | 6470 Shadow Creek Trail, Apt 5204, Melbourne, FL 32940 | 2020-06-26 |
| 1295360592 | Hiteshi Patel | Pharmacist | 3134 Hummingbird Way, Melbourne, FL 32940 | 2020-03-06 |
| 1972133122 | Curtis Lynn Curbo | Social Worker | 3830 Fringetree Lane, Melbourne, FL 32940 | 2020-01-16 |
| 1861038283 | Medfast Urgent Care Centers, LLC | Clinic/Center | 5500 Stadium Parkway, Melbourne, FL 32940 | 2019-11-20 |
| 1134601594 | Caroline Grace Bennett | Behavior Technician | 5500 Murrell Rd Suite 100, Melbourne, FL 32940 | 2018-09-02 |
| 1730682642 | Centennial Medical Group | Family Medicine | 1341 Bedford Drive, Melbourne, FL 32940 | 2018-03-16 |
| 1356849251 | Executive Non-emergency Transportation, Inc. | Non-emergency Medical Transport (VAN) | 3155-02 Suntree Blvd, Melbourne, FL 32940 | 2018-01-25 |
| 1679081160 | Brevard Oaks Center, LLC | Skilled Nursing Facility | 2355 Vidina Drive, Viera, FL 32940 | 2018-01-18 |
| 1275045817 | Comfortable Care Dental Health Professionals. P.a. | Dentist | 6340 N Wickham Rd Ste 101, Melbourne, FL 32940 | 2017-11-03 |
| Find all providers in zip 32940 | ||||
| Taxonomy Code | 363AS0400X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Surgical Technologist |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760888283 | Michael Dancy | Physician Assistant | 749 Mcdermott Ave, Melbourne, FL 32935-3038 | 2014-11-11 |
| 1164833240 | Stephen Schmoll | Physician Assistant | 205 E Nasa Blvd Fl 1, Melbourne, FL 32901-1950 | 2014-05-12 |
| 1174945521 | Dale P Greyslak Pa Pllc | Physician Assistant | 700 Jordan Blass Dr, Melbourne, FL 32940-1817 | 2014-01-19 |
| 1114163144 | Melissa L Hoppe | Physician Assistant | 3021 W Eau Gallie Blvd Ste 103, Suite 440, Melbourne, FL 32934-7005 | 2008-12-22 |
| 1144376088 | Carrie M Chapman | Physician Assistant | 1223 Gateway Dr Ste 2a, Melbourne, FL 32901-2607 | 2007-01-25 |
| 1972673184 | Physician Assistant Services of Florida LLC | Physician Assistant | 301 E Hibiscus Blvd, Melbourne, FL 32901-3105 | 2006-11-08 |
| 1013097567 | Miami First Assist, LLC | Physician Assistant | 1600 Sarno Road, Suite 15, Melbourne, FL 32935 | 2006-10-17 |
| 1336151067 | Bradley A Kramer | Physician Assistant | 8725 N Wickham Rd Ste 301, Melbourne, FL 32940-2240 | 2006-08-12 |
| 1649206517 | Eduardo Batista | Physician Assistant | 1600 Sarno Rd Ste 15, Melbourne, FL 32935-4990 | 2006-06-23 |
| 1548745037 | Kristin M. Kampenga | Physician Assistant | 1251 Hickory St, Melbourne, FL 32901-3221 | 2018-10-01 |
| Find all providers in MELBOURNE | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.