Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207QA0505X | Family Doctor - Adult Medicine | 11006182 | FL |
NPI | 1063028850 |
---|---|
Provider Name | Carline Grand-Pierre |
First Address | Lake Worth, FL 33463-7441 |
Second Address | Palm Springs, FL 33461-6917 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/09/2020 |
Last Update Date | 17/09/2020 |