Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC1500X | Nurse Practitioner - Community Health | APRN11011463 | FL |
NPI | 1164000402 |
---|---|
Provider Name | Audrey Jean Shockley-Cummings |
First Address | Englewood, FL 34223-2207 |
Second Address | Sarasota, FL 34237-6102 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/03/2021 |
Last Update Date | 30/03/2021 |