Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LG0600X | Nurse Practitioner - Gerontology | ARNP1222292 | FL |
NPI | 1053591065 |
---|---|
Provider Name | Claire A Petrie |
First Address | Pensacola, FL 32526-0277 |
Second Address | Pensacola, FL 32502 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/11/2007 |
Last Update Date | 24/07/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
306540500 | (05) | FL |