Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | ME129574 | FL |
NPI | 1750776597 |
---|---|
Provider Name | Dr. Ashley Parks |
First Address | Clearwater, FL 33759-3012 |
Second Address | St Petersburg, FL 33705-1300 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/03/2015 |
Last Update Date | 15/10/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
104209700 | (05) | FL |