Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207L00000X | Anesthesiologist | 005960 | AZ |
Y | 207L00000X | Anesthesiologist | OS11873 | FL |
N | 208000000X | Pediatrician | 005960 | AZ |
N | 208000000X | Pediatrician | OS11873 | FL |
NPI | 1013150234 |
---|---|
Provider Name | Dr. Tessa Elisabeth Baumgardner |
First Address | Phoenix, AZ 85012-1351 |
Second Address | Gainesville, FL 32610-3003 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/04/2009 |
Last Update Date | 30/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
009784800 | (05) | FL |