Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | C52314 | CA |
NPI | 1669593513 |
---|---|
Provider Name | Dr. Jocelyn Mae Mennie |
First Address | Tampa, FL 33612-4745 |
Second Address | Tampa, FL 33612-4745 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/04/2007 |
Last Update Date | 23/05/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C52314 | CALIFORNIA MEDICAL BOARD (01) | CA |