Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | 11007468 | FL |
NPI | 1083232052 |
---|---|
Provider Name | Ashley Bourcier |
First Address | Englewood, FL 34223-1749 |
Second Address | Englewood, FL 34223-4457 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2020 |
Last Update Date | 09/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F3N5 | BCBS (01) | FL |