Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | APRN11001553 | FL |
NPI | 1215400189 |
---|---|
Provider Name | Daniel Adam Nunnelly |
First Address | Brandon, FL 33511-7540 |
Second Address | Tampa, FL 33606-3571 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/01/2019 |
Last Update Date | 20/02/2019 |