Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0300X | Geriatric Medicine | ME0079170 | FL |
NPI | 1144302043 |
---|---|
Provider Name | Dr. Asha Lata Nagalla |
First Address | Windermere, FL 34786-8131 |
Second Address | Windermere, FL 34786-8131 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/10/2006 |
Last Update Date | 16/11/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
260158300 | (05) | FL |
C36317 | (02) |