Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | ARNP1607022 | FL |
N | 363LP0200X | Nurse Practitioner - Pediatrics | ARNP1607022 | FL |
NPI | 1033200043 |
---|---|
Provider Name | Dr. Doreen Radjenovic |
First Address | Rockland, DE 19732-0191 |
Second Address | Jacksonville, FL 32207-8426 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/09/2006 |
Last Update Date | 16/09/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
257733000 | (05) | FL |
783679869A | (05) | GA |
Q74645 | (02) |