Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 15268R | MS |
Y | 2084N0400X | Neurologist | 40164 | SC |
N | 2084N0400X | Neurologist | MD.15268R | LA |
N | 2084N0400X | Neurologist | ME121356 | FL |
NPI | 1093782575 |
---|---|
Provider Name | Anubha Jati |
First Address | Fort Myers, FL 33908-4133 |
Second Address | Aiken, SC 29801-6302 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/03/2006 |
Last Update Date | 01/05/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01457513 | (05) | MS |
015253500 | (05) | FL |
103055 | (02) | |
1196096 | (05) | LA |
IG927Z | (02) | FL |
PENDING | (05) | SC |