Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | 11016274 | FL |
NPI | 1194487140 |
---|---|
Provider Name | Chelsea Breanne Justice |
First Address | Matthews, NC 28104-6317 |
Second Address | Tampa, FL 33607-6307 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/10/2021 |
Last Update Date | 11/01/2022 |