Provider Demographics
NPI:1437893757
Name:LALUZ, MARIELA (ACNPC-AG)
Entity type:Individual
Prefix:
First Name:MARIELA
Middle Name:
Last Name:LALUZ
Suffix:
Gender:F
Credentials:ACNPC-AG
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2147
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33902-2147
Mailing Address - Country:US
Mailing Address - Phone:393-439-9602
Mailing Address - Fax:239-343-9977
Practice Address - Street 1:708 DEL PRADO BLVD S STE 6
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33990-2661
Practice Address - Country:US
Practice Address - Phone:239-424-2755
Practice Address - Fax:239-424-2756
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-22
Last Update Date:2025-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9402121363LA2100X
FLAPRN11019808363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL114332900Medicaid