Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | ARNP 9251837 | FL |
NPI | 1003352535 |
---|---|
Provider Name | Cecilia Ifeoma Ibe |
First Address | Raiford, FL 32083-1003 |
Second Address | Raiford, FL 32026-2648 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/01/2017 |
Last Update Date | 03/05/2018 |