Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LG0600X | Nurse Practitioner - Gerontology | 11008021 | FL |
NPI | 1043897572 |
---|---|
Provider Name | Javon Houston |
First Address | Orlando, FL 32868-1622 |
Second Address | Orlando, FL 32818-8301 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/03/2021 |
Last Update Date | 29/03/2021 |