Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LG0600X | Nurse Practitioner - Gerontology | 11015376 | FL |
NPI | 1013687771 |
---|---|
Provider Name | Gissy L Suarez |
First Address | Tampa, FL 33634-3017 |
Second Address | Tampa, FL 33634-3017 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/09/2021 |
Last Update Date | 15/09/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
11015376 | ARNP (01) | FL |