Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | APRN11009830 | FL |
NPI | 1023604006 |
---|---|
Provider Name | Alana Theodorou |
First Address | Clearwater, FL 33764-4642 |
Second Address | Clearwater, FL 33764-4642 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/12/2020 |
Last Update Date | 14/12/2020 |