Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | ARNP9189741 | FL |
N | 363LP0222X | Nurse Practitioner Pediatrics (Critical Care) | ARNP9189741 | FL |
NPI | 1033366364 |
---|---|
Provider Name | Jeanette Faith Green |
First Address | Longwood, FL 32779-2545 |
Second Address | Orlando, FL 32806-2032 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/08/2008 |
Last Update Date | 18/08/2008 |