Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | PY5808 | FL |
Y | 103T00000X | Psychologist | PY5808 | FL |
NPI | 1013055359 |
---|---|
Provider Name | Dr. Purnima Kumar |
First Address | Jacksonville, FL 32246-1876 |
Second Address | Jacksonville, FL 32207-4932 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/02/2007 |
Last Update Date | 08/11/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001905500 | (05) | FL |
779231363A | (05) | GA |