Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | ARNP9409775 | FL |
NPI | 1003325481 |
---|---|
Provider Name | Danaysi Bernal Del Agua |
First Address | Tampa, FL 33601-1289 |
Second Address | Tampa, FL 33603 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/09/2017 |
Last Update Date | 08/02/2019 |