Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0103X | Foot & Ankle Surgery | PO4085 | FL |
N | 213ES0103X | Foot & Ankle Surgery | SC006745 | PA |
NPI | 1013368257 |
---|---|
Provider Name | Carmelita Leslie Harbeson |
First Address | Pensacola, FL 32501-1721 |
Second Address | Pensacola, FL 32501 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2016 |
Last Update Date | 03/11/2020 |