Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | APRN9311035 | FL |
NPI | 1003335274 |
---|---|
Provider Name | Anne-Maria Hofmann Douglas |
First Address | Plantation, FL 33324-3923 |
Second Address | Port St Lucie, FL 34986-4527 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/09/2017 |
Last Update Date | 29/10/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
022875400 | (05) | FL |
ARNP9311035 | FLORIDA BOARD OF NURSING (01) | FL |
RN9311035 | FLORIDA BOARD OF NURSING (01) | FL |