Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 144224 | FL |
N | 207Q00000X | Family Doctor | TRN26730 | FL |
Y | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | 144224 | FL |
NPI | 1407341647 |
---|---|
Provider Name | Georgetta Bundley |
First Address | Tampa, FL 33606-3438 |
Second Address | Tampa, FL 33606-3438 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2018 |
Last Update Date | 03/07/2021 |