Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2080P0208X | Pediatric Infectious Diseases | 2017-00836 | NC |
Y | 2080P0208X | Pediatric Infectious Diseases | ME144340 | FL |
NPI | 1134418726 |
---|---|
Provider Name | Amelia Bianca Thompson |
First Address | Orlando, FL 32803-1469 |
Second Address | Orlando, FL 32803-1469 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/04/2011 |
Last Update Date | 23/07/2020 |