Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | P5970 | TX |
N | 208600000X | Surgeon | P5970 | TX |
N | 2086S0120X | Pediatric Surgery | 01072122A | IN |
N | 2086S0120X | Pediatric Surgery | MD-43496 | IA |
Y | 2086S0120X | Pediatric Surgery | ME115460 | FL |
N | 2086S0120X | Pediatric Surgery | P5970 | TX |
NPI | 1437304722 |
---|---|
Provider Name | Audrey Carmelita Durrant |
First Address | Orlando, FL 32891-0001 |
Second Address | Tampa, FL 33606-3603 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/12/2008 |
Last Update Date | 20/01/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
103854500 | (05) | FL |
3249054-02 | (05) | TX |
405897YKSJ | (02) | TX |
V4Z99 | BLUE CROSS BLUE SHIELD (01) | FL |