Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | APRN11010203 | FL |
NPI | 1083215446 |
---|---|
Provider Name | Erin Risavi Tongue |
First Address | Orlando, FL 32827-7224 |
Second Address | Orlando, FL 32806-8549 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/11/2020 |
Last Update Date | 17/11/2020 |