Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 2007-00526 | NC |
Y | 207QG0300X | Family Doctor - Geriatric Medicine | 2007-00526 | NC |
NPI | 1184837874 |
---|---|
Provider Name | Hadijatou Joyce Jarra |
First Address | Patrick Afb, FL 32925-3606 |
Second Address | Patrick Afb, FL 32925-3606 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/05/2007 |
Last Update Date | 06/10/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
145VY | BCBS (01) | NC |
5907226 | (05) | NC |