Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | ME128093 | FL |
N | 207QS0010X | Family Doctor - Sports Medicine | ME128093 | FL |
NPI | 1134566755 |
---|---|
Provider Name | Dusty Marie Narducci |
First Address | Orlando, FL 32891-0001 |
Second Address | Tampa, FL 33612-6601 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/05/2013 |
Last Update Date | 22/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
017546300 | (05) | FL |
Z5DPV | BLUE CROSS BLUE SHIELD (01) | FL |