Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | 11007799 | FL |
NPI | 1124645817 |
---|---|
Provider Name | Ashley Danielle Porcaro |
First Address | Lake Worth, FL 33467-7390 |
Second Address | Lake Worth, FL 33467-7390 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2020 |
Last Update Date | 29/06/2020 |