Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | ME125387 | FL |
N | 207Q00000X | Family Doctor | TRN20292 | FL |
NPI | 1003228131 |
---|---|
Provider Name | Dr. Carolina Vac Nelson |
First Address | St Petersburg, FL 33733-2868 |
Second Address | St Petersburg, FL 33702-1102 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/05/2014 |
Last Update Date | 27/09/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
022106900 | (05) | FL |