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Family >> Nurse Practitioner >> Physician Assistants & Advanced Practice Nursing Providers

Registrant NPI Number: 1538538459

Individual Registrant:
Gender: M
Sole Proprietor

Location and contact information for practice:
Tel: 863-946-0405  Fax: 863-847-2310

Contact information for business:
Tel: 561-844-9443  Fax: 561-844-1013

Registration Information:
NPI: 1538538459
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y363LF0000XPhysician Assistants & Advanced Practice Nursing Providers
Nurse Practitioner

Legacy codes, insurance codes and state license numbers:



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