Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | 9363062 | FL |
N | 363LF0000X | Nurse Practitioner - Family Medicine | 9363092 | FL |
NPI | 1174090500 |
---|---|
Provider Name | Genevieve San Nicolas |
First Address | Miami, FL 33136-1096 |
Second Address | Miami, FL 33136-1096 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/10/2018 |
Last Update Date | 19/08/2021 |