Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | 11010028 | FL |
NPI | 1003417072 |
---|---|
Provider Name | Carmen Moreno |
First Address | North Palm Beach, FL 33408-3512 |
Second Address | North Palm Beach, FL 33408-3512 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/11/2020 |
Last Update Date | 05/11/2020 |