Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | 11002664 | FL |
NPI | 1003476011 |
---|---|
Provider Name | Angela Marie Bumpus |
First Address | Land O Lakes, FL 34638-2607 |
Second Address | Land O Lakes, FL 34638-2607 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/06/2019 |
Last Update Date | 20/06/2019 |