Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0122X | Plastic and Reconstructive Surgery | ME150379 | FL |
NPI | 1194145292 |
---|---|
Provider Name | Dr. Jordan N Halsey |
First Address | Saint Petersburg, FL 33701-4804 |
Second Address | Saint Petersburg, FL 33701-4804 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/04/2014 |
Last Update Date | 28/07/2021 |