Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224P00000X | Prosthetist | CL1258447 | FL |
NPI | 1275091878 |
---|---|
Provider Name | Debbie Denizard |
First Address | Jacksonville, FL 32246-9932 |
Second Address | Jacksonville, FL 32208-7501 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/03/2019 |
Last Update Date | 04/03/2019 |