Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LF0000X | Nurse Practitioner - Family Medicine | 9166171 | FL |
Y | 363LP2300X | Nurse Practitioner - Primary Care | ARNP9166171 | FL |
NPI | 1033609789 |
---|---|
Provider Name | Anissa Brisbane-Mcfadden |
First Address | Jacksonville, FL 32277-2044 |
Second Address | Jacksonville, FL 32277-2042 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/05/2018 |
Last Update Date | 22/01/2019 |