Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156F00000X | Technician/Technologist | 46-5068589 | FL |
NPI | 1225542319 |
---|---|
Provider Name | Dana Hines |
First Address | Tallahassee, FL 32303-8360 |
Second Address | Tallahassee, FL 32303-8360 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/11/2017 |
Last Update Date | 28/11/2017 |