Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 11001492 | FL |
NPI | 1003372194 |
---|---|
Provider Name | Adam C Hargis |
First Address | Crestview, FL 32536-9356 |
Second Address | Crestview, FL 32539-5352 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/02/2019 |
Last Update Date | 27/02/2019 |