Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LC1500X | Nurse Practitioner - Community Health | 11013972 | FL |
Y | 363LF0000X | Nurse Practitioner - Family Medicine | APRN11013972 | FL |
NPI | 1649934118 |
---|---|
Provider Name | Christina Lee |
First Address | Fort Myers, FL 33902-2147 |
Second Address | Cape Coral, FL 33990-3289 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/10/2021 |
Last Update Date | 21/01/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
112402900 | (05) | FL |