Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 19576 | TN |
NPI | 1003206657 |
---|---|
Provider Name | Florida Allen |
First Address | Memphis, TN 38104-5905 |
Second Address | Memphis, TN 38109-2944 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/02/2015 |
Last Update Date | 30/03/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
Q013164 | (05) | TN |