Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | ME152250 | FL |
NPI | 1164771531 |
---|---|
Provider Name | Dr. Keisha Adams |
First Address | Orlando, FL 32891-0001 |
Second Address | Tampa, FL 33606-3571 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2012 |
Last Update Date | 18/10/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
111585500 | (05) | FL |
1164771531 | (05) | WI |
7YQ0B | BLUE CROSS BLUE SHIELD (01) | FL |