Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 174N00000X | Lactation Consultant | FL | |
Y | 176B00000X | Midwife | 380 | FL |
NPI | 1104187871 |
---|---|
Provider Name | Glenda Datsko |
First Address | Clearwater, FL 33756-3568 |
Second Address | Clearwater, FL 33756 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/05/2012 |
Last Update Date | 26/07/2019 |