Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YP1600X | Pastoral Counselor |
NPI | 1184854853 |
---|---|
Provider Name | Charlotte Eunice Fludd-Israel |
First Address | Tampa, FL 33635-6224 |
Second Address | Tampa, FL 33635-6224 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/07/2009 |
Last Update Date | 16/07/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
225479 | CI# / INTERNATIONAL FITNESS ASSOCIATION (01) | FL |