Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363L00000X | Nurse Practitioner | 10286 | CT |
Y | 363L00000X | Nurse Practitioner | 431172 | NY |
N | 363L00000X | Nurse Practitioner | CNP211642 | ME |
N | 363LA2100X | Nurse Practitioner - Acute Care | 95005814 | CA |
NPI | 1033656715 |
---|---|
Provider Name | Gaboy Jupiter |
First Address | Grayson, GA 30017-7847 |
Second Address | Visalia, CA 93291-9130 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/01/2017 |
Last Update Date | 01/02/2022 |