Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363L00000X | Nurse Practitioner | 9354510 | FL |
N | 363LA2100X | Nurse Practitioner - Acute Care | 9354510 | FL |
N | 363LC0200X | Nurse Practitioner - Critical Care Medicine | 9354510 | FL |
Y | 363LG0600X | Nurse Practitioner - Gerontology | APRN11000198 | FL |
NPI | 1255806584 |
---|---|
Provider Name | Eddie Denson |
First Address | Naples, FL 34102-5754 |
Second Address | Naples, FL 34102-5754 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/10/2018 |
Last Update Date | 08/02/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
017SG | BCBS (01) | FL |
101511900 | (05) | FL |