Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC1500X | Nurse Practitioner - Community Health | ARNP 1435092 | FL |
NPI | 1740332790 |
---|---|
Provider Name | Jeannie Short |
First Address | Clearwater, FL 33764-2829 |
Second Address | Clearwater, FL 33764-2829 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/01/2007 |
Last Update Date | 08/07/2007 |